Projecting non-communicable diseases attributable to air pollution in the climate change era: a systematic review

OBJECTIVES

Climate change is a major global issue with significant consequences, including effects on air quality and human well-being. This review investigated the projection of non-communicable diseases (NCDs) attributable to air pollution under different climate change scenarios.

DESIGN

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. A population-exposure-outcome framework was established. Population referred to the general global population of all ages, the exposure of interest was air pollution and its projection, and the outcome was the occurrence of NCDs attributable to air pollution and burden of disease (BoD) based on the health indices of mortality, morbidity, disability-adjusted life years, years of life lost and years lived with disability.

DATA SOURCES

The Web of Science, Ovid MEDLINE and EBSCOhost databases were searched for articles published from 2005 to 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The eligible articles were evaluated using the modified scale of a checklist for assessing the quality of ecological studies.

DATA EXTRACTION AND SYNTHESIS

Two reviewers searched, screened and selected the included studies independently using standardised methods. The risk of bias was assessed using the modified scale of a checklist for ecological studies. The results were summarised based on the projection of the BoD of NCDs attributable to air pollution.

RESULTS

This review included 11 studies from various countries. Most studies specifically investigated various air pollutants, specifically particulate matter <2.5 µm (PM2.5), nitrogen oxides and ozone. The studies used coupled-air quality and climate modelling approaches, and mainly projected health effects using the concentration-response function model. The NCDs attributable to air pollution included cardiovascular disease (CVD), respiratory disease, stroke, ischaemic heart disease, coronary heart disease and lower respiratory infections. Notably, the BoD of NCDs attributable to air pollution was projected to decrease in a scenario that promotes reduced air pollution, carbon emissions and land use and sustainable socioeconomics. Contrastingly, the BoD of NCDs was projected to increase in a scenario involving increasing population numbers, social deprivation and an ageing population.

CONCLUSION

The included studies widely reported increased premature mortality, CVD and respiratory disease attributable to PM2.5. Future NCD projection studies should consider emission and population changes in projecting the BoD of NCDs attributable to air pollution in the climate change era.

PROSPERO REGISTRATION NUMBER

CRD42023435288.

Cardiovascular risk prediction with cardio-ankle vascular index in the malaysian cohort study

The cardio-ankle vascular index (CAVI) is an important parameter assessing arterial function. It reflects arterial stiffness from the origin of the aorta to the ankle, and the algorithm is blood pressure independent. Recent data have suggested that a high CAVI score can predict future cardiovascular disease (CVD) events; however, to date, no study has been done in Malaysia. We conducted a prospective study on 2,168 The Malaysian Cohort (TMC) CVD-free participants (971 men and 1,197 women; mean age 51.64 ± 8.38 years old) recruited from November 2011 to March 2012. This participants were followed-up until the emergence of CVD incidence and mortality (endpoint between May to September 2019; duration of 7.5 years). Eligible participants were assessed based on CAVI baseline measurement which categorised them into low (CAVI <9.0) and high (CAVI ≥ 9.0) scores. The CVD events in the group with high CAVI (6.5 %) were significantly higher than in the low CAVI (2.6 %) group (p < 0.05). CAVI with cut-off point ≥ 9.0 was a significant independent predictor for CVD event even after adjustment for male, ethnicity, age, and intermediate atherogenic index of plasma (AIP). Those who have higher CAVI have 78 % significantly higher risk of developing CVD compared to those with the low CAVI (adjusted OR [95 % CI] = 1.78 [1.04 - 3.05], p =0.035). In addition, the participants with higher CAVI have significantly lower survival probability than those who have lower CAVI values. Thus, this study indicated that the CAVI can predict CVD event independently among the TMC participants.

Environmental and Occupational Factors Associated with Leptospirosis: A Systematic Review

Background

Leptospirosis is a neglected emerging zoonotic disease with a profound public health impact worldwide with higher burden of disease in resource-poor countries. The environmental and occupational exposures contribute to human and animal transmission, but the interaction was less explored. A deeper understanding of the critical environmental and occupational drivers in different contexts will provide useful information for disease control and prevention measures.

Objective

This review aimed to summarize the potential environmental and occupational risk factors associated with leptospirosis infection.

Methods

Four databases (Scopus, Web of Science, Ovid MEDLINE, EBSCOhost) were searched for articles published from 2012 to 2021. Eligible articles were assessed using a checklist for assessing the quality of the studies. The quality of the articles was assessed based on the laboratory diagnosis approach and statistical analysis method.

Results

A total of 32 studies were included in this systematic review. Water-related risk factors such as natural water as the primary water source (AOR 1.8-18.28), water-related recreational activities (AOR 2.36-10.45), flood exposure (AOR 1.54-6.04), contact with mud (AOR 1.57-4.58) and stagnant water (AOR 2.79-6.42) were associated with increased risk of leptospirosis. Infrastructural deficiencies such as un-plastered house walls and thatched houses presented a higher risk (AOR 2.71-5.17). Living in low-lying areas (AOR 1.58-3.74), on clay loam soil (OR 2.72), agricultural land (OR 2.09), and near rubber tree plantations (AOR 11.65) is associated with higher risk of leptospirosis. Contact with rats (AOR 1.4-3.5), livestock (AOR 1.3-10.4), and pigs (AOR 1.54-7.9) is associated with an increased risk of leptospirosis. Outdoor workers (AOR 1.95-3.95) and slaughterhouse workers (AOR 5.1-7.5) have higher risk of leptospirosis.

Conclusion

The environmental and occupational components related to water, infrastructure, landscape, agriculture, and exposed animals play an essential role in leptospirosis transmission. The magnitude of those risk factors differs with geographical region, climate factor, urbanization and population growth, and the country's socioeconomic status.

Elemental composition of Talang Queenfish (Scomberoides commersonnianus Lacépède, 1801) in relation to body size and condition factor from Pakistan

Abstract Fish is thought to be the most appropriate for indication of toxicity in water. So, purpose of present study was to determine the concentrations of few metals (Na, K, Ca, Mg, Fe, Cd, Pb and Zn) in relation to the body size and condition factor in Scomberoides commersonnianus. A total of 73 samples of marine fish, S. commersonnianus with various sizes that ranged from 93.4-1180 g of body weight and total length 20.5-56.9cm were randomly collected from the Arabian Sea of Karachi Pakistan, for examination of elemental composition. The concentration of Calcium found maximum while Cadmium found minimum in S. commersonnianus. Concentrations of Zn showed highly significant (P<0.001) negative, while Na and Ca exhibited strong positive correlation with the fish size. Correlations of Pb, K and Mg were found least significant (P<0.05) with the wet weight and total length of S. commersonnianus. Whereas, Fe and Cd were remained insignificantly correlated (P>0.05) with the fish size. Condition factor showed highly significant correlation (P<0.001) with all studied metals except cadmium and lead which were found insignificantly correlated (P>0.05) with condition factor of S. commersonnianus.

Evaluation of automated monitoring calving prediction in dairy buffaloes a new tool for calving management

Abstract Buffalo is one of the leading milk-producing dairy animals. Its production and reproduction are affected due to some factors including inadequate monitoring around parturition, which cause economic losses like delayed birth process, increased risk of stillbirth, etc. The appropriate calving monitoring is essential for dairy herd management. Therefore, we designed a study its aim was, to predict the calving based on automated machine measured prepartum behaviors in buffaloes. The data were collected from n=40 pregnant buffaloes of 2nd to 5th parity, which was synchronized. The NEDAP neck and leg logger tag was attached to each buffalo at 30 days before calving and automatically collected feeding, rumination, lying, standing, no. of steps, no. of switches from standing to lying (lying bouts) and total motion activity. All behavioral data were reduced to -10 days before the calving date for statistical analysis to use mixed model procedure and ANOVA. Results showed that feeding and rumination time significantly (P<0.05) decreased from -10 to -1 days before calving indicating calving prediction. Moreover, Rumination time was at lowest (P<0.001) value at 2h before the calving such behavioral changes may be useful to predict calving in buffaloes. Similarly, lying bouts and standing time abruptly decreased (P<0.05) from -3 to -1 days before calving, while lying time abruptly increased (P<0.01) from -3 to -1 days before calving (531.57±23.65 to 665.62±18.14, respectively). No. of steps taken and total motion significantly (P<0.05) increased from -10 to -1 days before calving. Feeding time was significantly (P<0.02) lowered in 3rd parity buffaloes compared with 2nd, 4th and 5th parity buffaloes, while standing time of 5th parity buffaloes were lowered (P<0.05) as compared to 2nd to 4th parity buffalos at -1 day of prepartum. However, rumination, lying, no. of steps taken and total motion activity at -1 day of prepartum was independent (P>0.05) of parity in buffaloes. Neural network analysis for combined variables from NEDAP technology at the daily level yielded 100.0% sensitivity and 98% specificity. In conclusion NEDAP technology can be used to measured behavioral changes -10 day before calving as it can serve as a useful guide in the prediction calving date in the buffaloes.

Size at sexual maturity estimation for 36 species captured by bottom and mid-water trawls from the marine habitat of Balochistan and Sindh in the Arabian Sea, Pakistan, using maximum length (Lmax) and logistic (L50) models

Abstract The aim of this study was to estimate the size at first sexual maturity (Lm) for 36 species belonging to 24 families from the marine habitat of Balochistan and Sindh in Arabian Sea, Pakistan through maximum length based an empirical and logistic model using commercial catch during June 2020 to May 2021. Individual total length (TL) was noted up to 0.1 cm using measuring broad. The Lm was calculated using two formulae; (i) log (Lm) = - 0.1246 + 0.9924 * log (Lmax) for Elasmobranchs and (ii) log (Lm) = -0.1189 + 0.9157* log (Lmax) for ray-finned fishes. The minimum Lm was recorded as 10.27 cm TL for Caranx malabaricus and 108.38 cm TL for Isurus oxyrinchus, respectively. Around Lm with 58.33% species were ranges from 19.00 cm to 25.00 cm TL. This study was estimated 16 newly Lm which is globally absent and rest 20 Lm are absent in the Arabian Sea (Pakistan coastal habitats). Therefore, the results will be helpful for the sustainable management and conservation of these marine fishes through the establishment of mesh size of trawl nets based on the size at sexual maturity (Lm).

Lactobacillus probiotics restore vaginal and gut microbiota of pregnant women with vaginal candidiasis

The development of probiotics has now included the areas along the gut-vaginal axis. We thus aimed to investigate the effects of lactobacilli probiotic to modulate and restore vaginal and gut microbiota of pregnant women with vaginal candidiasis (VC). A randomised, double-blind and placebo-controlled study was performed in 78 pregnant women with VC. Patients were randomised to either the probiotic (SynForU-HerCare) or placebo which were administered at baseline and continued for 8-weeks (two capsules/day of 9.5 log cfu/capsule). Microbiota profiles were assessed at time points of weeks-0, 4 and 8 for high vaginal swab and faecal samples. Shannon diversity index showed that after 8-weeks amid VC, a shift in microbial community compositional changes occurred in the high vaginal region at both genus (P=0.025) and species (P=0.044) levels, where the administration of probiotic prevented such a shift. These changes were mainly attributed to a decreased in abundance of Lactobacillus (P=0.042) accompanied by increased abundance of Prevotella (P=0.002) and Atopobium (P=0.002) in the placebo group while the probiotic group remained unchanged over time. The administration of probiotics also prevented a reduced abundance of faecal phylum Firmicutes after 8-weeks as seen in the placebo group (P<0.0001), which also showed reduction at subsequent taxonomic levels of class, family, genera and species. VC has not only altered the microbiota of vagina regions but also gut microbiota profiles, causing lessening of gut microbiota that are crucial for gut nutrient availability, protection and immunity. The administration of lactobacilli probiotics has prevented such a shift, leading to better modulated gut and vaginal microenvironment amid VC. The study was registered at ClinicalTrials.gov: identifier number NCT03940612.

Risk perception and its predictors towards type 2 diabetes mellitus among students in Universiti Kebangsaan Malaysia

Type 2 diabetes mellitus (T2DM) has become increasingly prevalent among young adults. Risk perception is believed to be an important determinant of preventive health behaviors; however, young adults remain unaware of the benefits. The current study aimed to examine Malaysian public university students' perceived risk of developing T2DM and its predictors. This cross-sectional study involved a total of 1078 healthy students at Universiti Kebangsaan Malaysia (UKM). The validated Malay version of the Questionnaire on Risk Perception of Developing Non-Communicable Diseases in Malaysia was used to assess their perceived risk of developing T2DM in the future. Multiple logistic regression was used to analyze the data regarding the predictors of perceived risk to obtain the final model after controlling the potential confounders. . It was found that the majority of respondents (83.8%) perceived low risk of developing T2DM. Results from the multiple logistic regression indicated that respondents from non-health related faculties (OR, 1.71: 95% CI 1.162, 2.515), smoking (OR, 8.43: 95% CI 1.108, 64.130), consume fast food ≥ 3 times/month (OR, 1.56: 95% CI 1.104, 2.207), and snacking ≥ 3 times/week (OR, 1.79: 95% CI 1.262, 2.550) were significant positive predictors while family history of diabetes was a negative predictor (OR, 0.50: 95% CI 0.350, 0.695). Students who self-rated themselves as practising healthy lifestyles and actively seeking health information perceived a low risk of developing diabetes in the future. . The findings indicate that students perceived their risk as low even though they have the risk. This creates an urgent need to emphasize the necessity of diabetes prevention education, especially on socio-behavioral factors, to address the widespread misunderstandings among university students regarding diabetes risk factors to reduce diabetes incidence.

Genetic and morphological concordance and discordance within the Cyrtodactylus brevipalmatus group (Squamata: Gekkonidae)

We use data sets from the Cyrtodactylus brevipalmatus group with limited genetic and morphological sampling to demonstrate that not accounting for sampling error may adversely influence decisions regarding species delimitation and diagnosis. Lack of geographic sampling between the endpoints of a species range may recover notable interpopulational genetic differentiation consistent with species-level differentiation. Additionally, small population sample sizes may fail recover statistically different diagnostic morphological differences. Combined, these types of sampling error can produce results seemingly consistent with the recognition of cryptic speciesgenetically delimited populations lacking diagnostic morphological characters. This is the current situation within some lineages of the C. brevipalmatus group whereas in others, sampling error is less problematic and does not jeopardize their taxonomy. We note the potential negative effects for comparative biology as a whole if sampling error is not taken into consideration prior to constructing taxonomies.

AN EVALUATION OF ANTIBIOTIC PRESCRIPTION PRACTICES: PERSPECTIVES OF VETERINARY TRAINEES AND PRACTICING VETERINARIANS

Antibiotic resistance is a major worldwide problem that has an impact on the well-being of humans as well as animals. Antibiotic resistance is caused by the misuse and excessive use of antibiotics. The key to reducing this issue lies in educating veterinary medical learners on the proper and accountable utilization of antibiotics for the care of animals. Objective - using awareness-raising and instruction as the foundation, this research of Indian veterinary learners can help resolve the issue of antibiotic resistance throughout the care of animals. The questionnaire survey was taken between June and July 2022 and it was aimed at learners registered in veterinary medical studies at academic and research institutions in India. The study included 500 pupils overall. The purpose of the survey was to gather information about students' knowledge of antibiotics, including antibiotic resistance, as well as their feelings on the consequences of antibiotic resistance on the globe at large and their acquaintance with the one health ideology. According to this study's findings, 83.3 percent of respondents thought antibiotic resistance was a serious problem. 57.92 percent of respondents understood the issue's worldwide consequences and its one health ideology. The study emphasizes the significance of expanding the veterinary educational program to include thorough instruction on prudent antibiotic usage and the concepts of one health.

UNDERSTANDING THE ADAPTATION AND SENSITIVITY OF THE MICROBIOME: MICROBIAL RESILIENT AND HUMAN WELL-BEING

The term microbiome describes the assortment of microbes that dwell in and on a person's body, particularly in the gut, comprising fungi, bacteria, infectious agents and additional microbes. According to research, numerous elements of human well-being, such as digestion, immunological response and psychological well-being, have been linked to the microbiome. Preserving human wellness requires knowledge of the microbiome's stability and how it reacts to perturbations. According to preliminary research, adults' microbial ecosystems are considered stable with no signs of significant disturbances. This stability is not preserved by inertia and the system's interaction with restorative forces keeps the processes stable. Short antibiotic doses can result in quick and substantial microbiome alterations. However, there is confirmation that the taxonomic structure of the microbiome has at least recovered after such disruptions. The effect of antibiotics is individualized and can be altered by earlier exposure to a similar drug, which is a crucial aspect to remember. These results suggest that the individual's microbiome has adaptable qualities. Examining the microbiome's reactions to perturbations might be helpful in the prediction of potential instabilities and illness by revealing important features of function, microbial connections, and important species in the native microbiota. This information can benefit the management of the individual microbial community and the promotion of better health conditions.

Survival Rate and Prognostic Factors of Localised Prostate Cancer in Southeast Asian Countries: A Systematic Review with Meta-Analysis

Prostate cancer (Pca) is one of the most prevalent health conditions affecting men, particularly older men, and cases have increased in recent years.

OBJECTIVE

This review examined the survival rate and prognostic factors of patients with Pca in Southeast Asia (SEA).

METHODS

We conducted a systematic search of three databases (PubMed, Scopus, Web of Science) and a manual search until April 1, 2022. The selected papers were evaluated using the Newcastle-Ottawa Quality Assessment Form for Cohort Studies. The review protocol was registered with PROSPERO (CRD42022326521). Pooled prevalence rates were calculated using the programme R version 4.2.1. Heterogeneity was assessed using the I2 statistic and p-value. A narrative approach was used to describe prognostic factors. Studies were selected and finalised based on the review question. The quality of the included studies was assessed.

RESULTS

A total of 11 studies were included in this review. The 1-, 3-, 5- and 10-year survival rates of SEA Pca cases were 80.8%, 51.9%, 66.1% (range 32.1-100) and 78% (range 55.9-100), respectively. Prognostic factors for Pca were discussed in terms of sociodemographic, disease-related and treatment-related aspects. The predictors of significantly lower survival were age more than 75 years, cancer detected during transurethral resection of the prostate, Gleason score more or equal to eight, high-risk group, metastases and no adjuvant radiotherapy. A meta-analysis on the pooled HR of prostate cancer could not be performed due to the heterogeneity of prognostic factors. The pooled prevalence of localised and metastatic prostate cancer in SEA countries was 39% 95% CI [20-62] and 40% 95% CI [28-53], respectively.

CONCLUSION

The survival rate in SEA countries can be determined by prognostic factors, which can be divided into sociodemographic, disease-related and treatment-related factors. Therefore, further studies are needed to improve the understanding and treatment of Pca in the region SEA.

A randomized controlled trial on the effect of smartphone-based mental health application among outpatients with depressive and anxiety symptoms: A pilot study in Malaysia

Introduction

Despite the increasing number of mental health professionals in Malaysia, many have yet to receive adequate treatment for common mental illnesses such as depression and anxiety. Coupled with the increasing number of mobile phone users globally, smartphone-based intervention can be a promising mental health intervention. Thus, this study aims to investigate the efficacy of using a smartphone-based mental health application in addition to treatment-as-usual (TAU) in outpatients with depressive and/or anxiety symptoms.

Methods

Psychiatric outpatients that fulfill the selection criteria were recruited and randomized into two groups, the intervention group (n = 24) and the control group (n = 24). Those in the intervention group received MoodMission in addition to TAU, while those in the control group received TAU. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores were assessed at baseline and after four weeks.

Results

A total of 48 participants were recruited, randomized, and completed the study. Baseline characteristics for both groups were comparable. There is no significant mean difference between-group comparison of PHQ-9 (1.31, 95% CI -1.35, 3.98) and GAD-7 (0.02, 95% CI -2.01, 2.05) scores at four weeks. However, for the intervention group, there was a significant improvement in the PHQ-9 score at four weeks [mean difference 2.58 (95% CI 1.16, 4.01), P = 0.001)].

Conclusion

This study showed no significant improvement in anxiety symptoms after four weeks. Use of smartphone-based mental health applications led to significant reduction of depressive symptoms.

Risk perception of non-communicable diseases: A systematic review on its assessment and associated factors

BACKGROUND

The burden of non-communicable diseases (NCDs) is increasing. Risk perception of NCDs is an important factor towards the uptake of preventive health interventions. There are various questionnaires assessing risk perception of NCDs, but no internationally standardized questionnaire has been available. Identification of factors associated with risk perception of NCDs may facilitate the development of targeted interventions. This systematic review aims to identify available questionnaire assessing risk perception of NCDs and the factors associated with risk perception of NCDs.

METHODS

The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original article published in English between 2012 and 2021. Quality appraisal of the eligible articles was conducted using the Mixed Methods Appraisal Tool. Findings were synthesized using content analysis.

RESULTS

A total of 86 studies were included. We found a variety of questionnaires assessing risk perception of NCDs, with many differences in their development, domains, items and validity. We also identified several personal, sociopsychological and structural factors associated with risk perception of NCDs.

LIMITATIONS

Most of the included studies were of cross-sectional design, and therefore the quality of evidence was considered low and exhibit a high risk of bias. The role of publication bias within this systematic review should be acknowledged as we did not include grey literature. Additionally, language bias must be considered as we only included English-language publications.

CONCLUSION

Further development and testing of available questionnaire is warranted to ensure their robustness and validity in measuring risk perception of NCDs. All the identified factors deserve further exploration in longitudinal and experimental studies.

Assessment of indoor thermal comfort temperature and related behavioural adaptations: a systematic review

Thermal comfort is linked to our health, well-being, and productivity. The thermal environment is one of the main factors that influence thermal comfort and, consequently, the productivity of occupants inside buildings. Meanwhile, behavioural adaptation is well known to be the most critical contributor to the adaptive thermal comfort model. This systematic review aims to provide evidence regarding indoor thermal comfort temperature and related behavioural adaptation. Studies published between 2010 and 2022 examining indoor thermal comfort temperature and behavioural adaptations were considered. In this review, the indoor thermal comfort temperature ranges from 15.0 to 33.8 °C. The thermal comfort temperature range varied depending on several factors, such as climatic features, ventilation mode, type of buildings, and age of the study population. Elderly and younger children have distinctive thermal acceptability. Clothing adjustment, fan usage, AC usage, and open window were the most common adaptive behaviour performed. Evidence shows that behavioural adaptations were also influenced by climatic features, ventilation mode, type of buildings, and age of the study population. Building designs should incorporate all factors that affect the thermal comfort of the occupants. Awareness of practical behavioural adaptations is crucial to ensure occupants' optimal thermal comfort.

The Impact of Vitamin D Deficiency and Insufficiency on the Outcome of Type 2 Diabetes Mellitus Patients: A Systematic Review

Vitamin D deficiency and insufficiency are public health concerns that have contributed to multiple negative health outcomes. Recent studies have revealed that vitamin D deficiency and insufficiency influence glycaemic control and the development of diabetes complications. The goal of this systematic review is to summarise the latest evidence on the impact of vitamin D deficiency and insufficiency on the outcome of Type 2 Diabetes Mellitus (T2DM) patients. In this PRISMA-guided systematic review, articles were sourced from three databases, namely, PubMed, Scopus, and Web of Science. The review only included literature published from 2012 until 2022, and 33 eligible studies met the inclusion criteria for this review. The included articles were critically appraised using the Mixed Method Appraisal Tool (MMAT). According to our findings, vitamin D deficiency or insufficiency is associated with mental health status, macrovascular and microvascular complications of T2DM, metabolic syndrome, increased risk of obesity, increased blood pressure, dyslipidaemia, glycaemic control, nerve-related disease, musculoskeletal-related complications, and reduced quality of life. Due to the diverse implications of vitamin D deficiency and insufficiency, screening for vitamin D levels in T2DM patients may be beneficial.

Single centre experience of 120 patients with non-infectious aortitis: Clinical features, treatment and complications

BACKGROUND

Aortitis is an important form of vasculitis with significant risk of complications. Very few studies have provided detailed clinical phenotyping across the whole disease spectrum. Our primary aim was to look the clinical features, management strategies and complications associated with non-infectious aortitis.

METHODS

A retrospective review was performed on patients with diagnosis of noninfectious aortitis at the Oxford University hospitals NHS Foundation Trust. Clinicopathologic features were recorded including demographics, presentation, aetiology, laboratory, imaging findings, histopathology, complications, treatment, and outcome.

RESULTS

We report the data on 120 patients (59% females). Systemic inflammatory response syndrome constituted the most common presentation (47.5%). 10.8% were diagnosed following a vascular complication (dissection or aneurysm). All patients (n = 120) had raised inflammatory markers (median ESR 70.0 mm/h and CRP 68.0 mg/L). Isolated aortitis subgroup (15%) had significantly higher likelihood of presenting with vascular complications and challenging to diagnose due to non-specific symptoms. Prednisolone (91.5%) and methotrexate (89.8%) were the most used treatment. 48.3% developed vascular complications during the disease course including ischaemic complications (25%), aortic dilatation and aneurysms (29.2%) and dissection (4.2%). Risk of dissection was higher in the isolated aortitis subgroup at 16.6% compared to all other types of aortitis at 1.96%.

CONCLUSION

Risk of vascular complications is high in non-infectious aortitis patients during disease course, hence early diagnosis and appropriate management is key. DMARDs such as Methotrexate appear to be effective, nonetheless there remain gaps in evidence for longer-term management of relapsing disease. Dissection risk seems much higher for patients with isolated aortitis.

The lipid-lowering efficacy of rosuvastatin is associated with variations in SLCO1B1: a 12-month prospective cohort study

OBJECTIVE

Statins' efficacy and safety are subject to wide inter-individual variability, partly due to genetic predisposition. Studies have shown that the genetic variations in the common solute carrier organic anion transporter family member 1B1 (SLCO1B1) gene polymorphisms affect the transport of statins' transport into hepatocytes, their plasma concentration, and circulation time. The ultimate result is variable and personalized statins response and statin-associated muscular symptoms (SAMS). Here we report an update on the differential response to rosuvastatin therapy in the Pakistani population.

PATIENTS AND METHODS

A total of 166 hyperlipidemic patients on rosuvastatin were prospectively followed for 24 weeks. Muscle symptoms were recorded after 6-8 weeks of therapy, and assessment was done according to the SAMS-clinical index tool. Patients were genotyped for SLCO1B1 c.521T>C and c.388A>G polymorphisms, for association with lipid-lowering response and statin-associated muscle symptoms. The plasma level of rosuvastatin was determined through Liquid chromatography-mass spectrometry (LCMS) for possible correlation with adverse effects and lipid-lowering efficacy.

RESULTS

Mean reduction in low-density lipoprotein cholesterol (LDL-C) was 42.34 mg/dl (p<0.001), 35.66 mg/dl (p<0.001), and 24.47 mg/dl (p=0.202) in reference, heterozygous and mutant homozygous groups of SLCO1B1 c.521T>C, respectively. A 15.70% and 42.14% diminished LDL-C reduction was observed in c.521TC and c.521CC, respectively, compared to the reference c.521TT genotype. Similarly, for SLCO1B1 c.388A>G, 20.50% and 29.40% less LDL-C lowering effect was observed in heterozygous and mutant homozygous carriers, respectively. SAMS were observed in 37% and 33% of heterozygous and minor homozygous, respectively, (p=0.059). The rosuvastatin plasma level was 1.89-fold higher in the c.521CC genotype than in the reference homozygous type.

CONCLUSIONS

Differential lipid-lowering response and muscular symptoms due to rosuvastatin are associated with the SLCO1B1 common polymorphisms. Further studies are needed to validate dose adjustment and rationalization.

Hypercholesterolemia in the Malaysian Cohort Participants: Genetic and Non-Genetic Risk Factors

Hypercholesterolemia was prevalent in 44.9% of The Malaysian Cohort participants, of which 51% were Malay. This study aimed to identify the variants involved in hypercholesterolemia among Malays and to determine the association between genetic and non-genetic risk factors. This nested case–control study included 25 Malay participants with the highest low-density lipoprotein cholesterol (LDL-C, >4.9 mmol/L) and total cholesterol (TC, >7.5 mmol/L) and 25 participants with the lowest LDL-C/TC. Genomic DNA was extracted, and whole-exome sequencing was performed using the Ion ProtonTM system. All variants were annotated, filtered, and cross-referenced against publicly available databases. Forty-five selected variants were genotyped in 677 TMC Malay participants using the MassARRAY® System. The association between genetic and non-genetic risk factors was determined using logistic regression analysis. Age, fasting blood glucose, tobacco use, and family history of hyperlipidemia were significantly associated with hypercholesterolemia. Participants with the novel OSBPL7 (oxysterol-binding protein-like 7) c.651_652del variant had 17 times higher odds for hypercholesterolemia. Type 2 diabetes patients on medication and those with PCSK9 (proprotein convertase subtilisin/kexin type 9) rs151193009 had low odds for hypercholesterolemia. Genetic predisposition can interact with non-genetic factors to increase hypercholesterolemia risk in Malaysian Malays.

Impact of COVID-19 Pandemic on Healthcare Utilization among Patients with Type 2 Diabetes Mellitus: A Systematic Review

As the COVID-19 pandemic continues, healthcare services have been grossly overwhelmed by the pandemic. Due to this circumstance, routine care for individuals with type 2 diabetes mellitus (T2DM) has been temporarily disrupted. The purpose of this systematic review was to summarize the evidence regarding the impact of the COVID-19 pandemic on healthcare utilization among patients with T2DM. A systematic search was conducted in the Web of Science, Scopus, and PubMed databases. The process of identifying the final articles followed the PRISMA guidelines. The inclusion criteria were articles published between 2020 and 2022, written in English, and studies focusing on the research question. Any proceedings and books were excluded. A total of fourteen articles relevant to the research question were extracted. Following that, the included articles were critically appraised using the Mixed Method Appraisal Tool (MMAT) and the Joanna Briggs Institute Critical Appraisal Tool to assess the quality of the studies. The findings were further classified into three themes: reduced healthcare utilization among T2DM patients in routine healthcare services, a surge of telemedicine usage, and delay in the delivery of healthcare services. The key messages include demands for monitoring the long-term effects of the missed care and that better preparedness is crucial for any pandemic in the future. A tight diagnostic workup at the community level and regular follow-ups are crucial in managing the impact of the pandemic among T2DM patients. Telemedicine should be on the agenda of the health system to maintain and complement healthcare services. Future research is warranted to determine effective strategies to deal with the impact of the pandemic on healthcare utilization and delivery among T2DM patients. A clear policy is essential and should be established.

Prevalence and Associated Factors of E-Cigarette Use among Adolescents in Southeast Asia: A Systematic Review

The use of e-cigarettes in adolescents remains a major public health concern. Like other tobacco products, e-cigarettes pose health risks to adolescents. Understanding the magnitude of this problem and identification of its associated factors will serve as a guide for development of preventive interventions. This systematic review aims to identify and discuss current epidemiological data on the prevalence and associated factors of e-cigarette use among adolescents in Southeast Asia. The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original English-language articles published between 2012 and 2021. A total of 10 studies were included in this review. The prevalence of current e-cigarette uses ranges from 3.3% to 11.8%. Several associated factors of e-cigarette use were identified, including sociodemographic factors, traumatic childhood experience, peer and parental influence, knowledge and perception, substance use, and accessibility of e-cigarettes. These factors should be addressed though multifaceted interventions which simultaneously target multiple factors. Laws, policies, programs, and interventions must be strengthened and tailored to the needs of adolescents at risk of using e-cigarettes.

Issues and Challenges in the Primary Prevention of Type 2 Diabetes Mellitus: A Systematic Review

BACKGROUND

Primary prevention of type 2 diabetes mellitus (T2DM) is possible in at-risk populations, and prevention programmes have been shown to be effective in real-world scenarios. Despite this evidence, diabetes prevalence has tripled in recent decades and is expected to reach 700 million patients by 2045, making it one of the leading causes of death globally. This review is aimed at identifying the issues and challenges in the primary prevention of T2DM.

METHODS

Scopus, Web of Science, PubMed and Ovid MEDLINE were systematically searched for published articles. Articles were screened based of inclusion and exclusion criteria. The inclusion criteria were: (1) published in 2010-2020, (2) full original article, (3) written in English, (4) qualitative, mixed-methods article, observational or interventional study. The exclusion criteria were: (1) animal study, (2) in vivo/in vitro study, (3) type 1 diabetes or gestational DM and (4) conference abstract, book chapter, report, and systematic review. Eligible articles were assessed using Mixed Methods Appraisal Tool (MMAT) by three assessors.

RESULTS

A total of 11 articles were selected for qualitative synthesis from the initial 620 articles. The issues and challenges seen in T2DM primary prevention followed three themes: healthcare program (sub-themes: lack of resources, community partnership, participation, health literacy), health provider (sub-themes: lack of implementation, health care staff, collaboration, availability), individual (sub-themes: awareness, communication, misbehaviour, family conflict).

CONCLUSION

Factors relating to healthcare programmes, health providers, and individual issues are the main challenges in T2DM primary prevention. By establishing sustainable preventative initiatives that address these issues and challenges in the primary prevention of T2DM, a reduction in T2DM prevalence could be achievable.

Growth, physiological, biochemical and molecular changes in plants induced by magnetic fields: A review

The Earth's geomagnetic field (GMF) is an inescapable environmental factor for plants that affects all growth and yield parameters. Both strong and weak magnetic fields (MF), as compared to the GMF, have specific roles in plant growth and development. MF technology is an eco-friendly technique that does not emit waste or generate harmful radiation, nor require any external power supply, so it can be used in sustainable modern agriculture. Thus, exposure of plants to MF is a potential affordable, reusable and safe practice for enhancing crop productivity by changing physiological and biochemical processes. However, the effect of MF on plant physiological and biochemical processes is not yet well understood. This review describes the effects of altering MF conditions (higher or lower values than the GMF) on physiological and biochemical processes of plants. The current contradictory and inconsistent outcomes from studies on varying effects of MF on plants could be related to species and/or MF exposure time and intensity. The reviewed literature suggests MF have a role in changing physiological processes, such as respiration, photosynthesis, nutrient uptake, water relations and biochemical attributes, including genes involved in ROS, antioxidants, enzymes, proteins and secondary metabolites. MF application might efficiently increase growth and yield of many crops, and as such, should be the focus for future research.

Causes, factors, and complications associated with hospital admissions among patients with Parkinson's disease

Introduction

Patients with Parkinson's disease (PD) are at a higher risk of hospital admissions compared to the general population. We studied the causes and factors associated with admissions among patients with PD over 6 years.

Methods

We included all PD admissions between 1 January 2016 and 31 December 2021. Other causes of parkinsonism were excluded. Causes of admissions were divided into PD-related (direct or indirect) or non-PD-related. The type of admission was categorized into emergency or elective.

Results

We identified 605 hospital admissions (259 patients with PD); 345 (57.0%) were PD-related and 260 (43%) were non-PD-related. Emergency PD admissions contributed to 50.4% of all admissions, most commonly from respiratory infection (23%). PD admissions in comparison to non-PD admissions were associated with worse disease severity (HY ≥ 3; p < 0.001), longer disease duration [8.71 (SD 6.23) vs. 6.60 (SD 5.39) years; p < 0.001], and longer hospital stay [7.70 (SD 5.89) vs. 6.42 (SD 7.63) days; p = 0.020]. Non-PD admissions were associated with more comorbidities (97.3%; p = 0.013). There were 124 (20.5%) complications and 31 deaths (5.1%). A total of 29 deaths were due to respiratory infection and 3 deaths were due to COVID-19 pneumonia. Emergency admission (PD- and non-PD-related; p = 0.001) and respiratory-related causes (p < 0.001) were predictors of unfavorable hospital admission outcomes (death and complications).

Conclusion

Respiratory infection was the leading cause of hospital admission and a significant independent predictor of unfavorable hospital admission outcomes (death and complications). PD-related admissions were associated with disease severity and led to more complications and longer hospital stays. Non-PD-related admissions were associated with comorbidities.

The Impact of Heatwaves on Mortality and Morbidity and the Associated Vulnerability Factors: A Systematic Review

BACKGROUND

This study aims to investigate the current impacts of extreme temperature and heatwaves on human health in terms of both mortality and morbidity. This systematic review analyzed the impact of heatwaves on mortality, morbidity, and the associated vulnerability factors, focusing on the sensitivity component.

METHODS

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. Four databases (Scopus, Web of Science, EBSCOhost, PubMed) were searched for articles published from 2012 to 2022. Those eligible were evaluated using the Navigation Guide Systematic Review framework.

RESULTS

A total of 32 articles were included in the systematic review. Heatwave events increased mortality and morbidity incidence. Sociodemographic (elderly, children, male, female, low socioeconomic, low education), medical conditions (cardiopulmonary diseases, renal disease, diabetes, mental disease), and rural areas were crucial vulnerability factors.

CONCLUSIONS

While mortality and morbidity are critical aspects for measuring the impact of heatwaves on human health, the sensitivity in the context of sociodemographic, medical conditions, and locality posed a higher vulnerability to certain groups. Therefore, further research on climate change and health impacts on vulnerability may help stakeholders strategize effective plans to reduce the effect of heatwaves.

Knowledge of chronic kidney disease among undergraduate and postgraduate students in a public university in Klang Valley, Malaysia: A cross sectional study

The prevalence of chronic kidney disease (CKD) risk factors such as diabetes mellitus, hypertension, and obesity among the young Malaysians are increasing. Understanding the factors associated with CKD knowledge could assists healthcare providers to design health education programmes. There are scarce local studies on CKD knowledge and its associated factors among university students. This subpopulation comprises of young people with diverse background and characteristics. This study was aimed to assess the CKD knowledge and its associated factors among university students. A cross-sectional study was conducted among Universiti Kebangsaan Malaysia students from July 2020 to August 2020. A convenience sampling method was applied. All students were invited to complete an online survey using Google Forms that were sent to their email. The survey consisted of questions related to their sociodemographic, socioeconomics, university programme enrolled, medical history, lifestyle characteristics and CKD knowledge. The data were analysed using SPSS Statistics 26.0. Multiple logistic regression analysis was performed to identify the final associated factors after controlling for confounders. A total of 3074 students participated and 32.6% of them had below average CKD knowledge. Students of male gender, enrolment in undergraduate programmes and non-health-related faculties/institutes were more likely to have below average CKD knowledge. Students who are Chinese, from high monthly household income family and with family history of CKD were less likely to have below average CKD knowledge. Almost one-third of the students had below average CKD knowledge. The six associated factors with CKD knowledge were non-modifiable. Of the six factors, three were associated with students being more likely to have below average CKD knowledge; another three were associated with students being less likely to have below average CKD knowledge. Future health education programmes to enhance CKD knowledge should be designed focusing on students who are more likely to have below average CKD knowledge.

Human brucellosis: Six years retrospective study on seropositivity in Malaysia

INTRODUCTION

Human brucellosis is a zoonotic disease in Malaysia. This study analysed six-year retrospective seropositivity trends of human brucellosis cases from 2014 to 2019.

METHODS AND MATERIALS

A total of 1,281 serum samples were obtained from suspected brucellosis patients were included. The sera were tested using an enzyme-linked immunosorbent assay for IgM and IgG antibodies for Brucella spp. Samples with equivocal or positive antibody index were confirmed with an immunocapture agglutination.

RESULTS

During the study period, 5.8% (n=74) of suspected cases showed seropositivity for human brucellosis. The central region has the highest seropositivity cases of human brucellosis. Consumption of unpasteurised milk was significantly associated with human brucellosis in this study with adjusted odds ratio ((AOR) = 4.56, 95% CI = 2.6, 8.02, p-value < 0.001). The age group of less than 15 years old was more likely to contract brucellosis ((AOR) = 2.81, 95% CI = 1.01, 7.84 p-value < 0.048).

CONCLUSION

Serological tests have been widely used for the diagnosis of human brucellosis. However, diagnosis using serology is often challenging without the presence of a convalescent sample. In conclusion, even though human brucellosis has a low prevalence rate, the disease has serious public health implications. The usage of effective diagnostic tools as well as implementation of 'One Health' approach are the way forward to prevent and control of brucellosis in the country.

Community-acquired Covid-19 Cluster among Non-Clinical Staff in a Teaching Hospital, Malaysia

A novel coronavirus, COVID-19 is responsible for the current outbreak of pneumonia. As of 16 September 2021, a total of 2,049,750 COVID-19 cases were recorded in Malaysia. In this study, we aimed to describe a cluster of COVID-19 cases among non-clinical staff in a teaching hospital in Kuala Lumpur Malaysia. We obtained epidemiological and clinical data from patients with confirmed COVID-19, via phone interviews and patient medical records. We performed chronological mapping of the cases to identify the possible period, mode of transmission, and cluster pattern. Three laboratory-confirmed COVID-19 cases were identified from the teaching hospital cluster. These three cases were linked epidemiologically to the religious gathering cluster in Malaysia. Seventy-four close contacts consisting of teaching hospital staff were quarantined. The median incubation period was four days (IQR 1-7). The need for intensified surveillance and a high level of alertness is vital to minimise the risk of widespread transmission in Malaysia.  

POS0958 PROGRESSIVE IMPROVEMENT IN TIME TO DIAGNOSIS IN AXIAL SPONDYLOARTHRITIS THROUGH AN INTEGRATED REFERRAL AND EDUCATION SYSTEM

Background

Despite the advances in the treatment and management of axial spondyloarthritis (axSpA), there remains a significant delay in the diagnosis of the condition. The diagnostic delay is 8-10 years in Europe and 8.5 years on average in the United Kingdom. This is contributed by the lack of awareness of axSpA, limited access to diagnostic tests and unstructured referral pathways. The delayed diagnosis leads to higher morbidity from the condition.

Objectives

To assess the delay in the diagnosis of axSpA over time in a real world axSpA cohort diagnosed over a 7 year period from 2015 and to evaluate factors associated with this delay. During this time, we evaluated the effectiveness of the interventions to reduce the delay to diagnosis.

Methods

A cohort of axSpA patients newly diagnosed between 2015 to 2021, were studied. This was a cross-sectional study on patients with axSpA who visited a specialist rheumatology clinic at a single centre. The demographic, clinical and diagnostic variables were recorded. Diagnostic delay was defined as the time interval between the year of first symptom and year of diagnosis. The mean and median diagnostic delay were calculated. An integrated educational and referral system were implemented from 20151. This included education to the main referrers in to the system including general practitioners (GPs) and community musculoskeletal (MSK) triage physiotherapists. The electronic referral systems were updated annually according to best practice guidelines2. An impact analysis was performed evaluating diagnostic delay for axSpA during this period.

Results

Of the 110 axSpA patients studied, 60 (54.4%) were male and 50 (45.5%) female. The mean (range) age was 37 (18-52) years. All patients met the ASAS classification criteria for axSpA. Radiographic axSpA (Ankylosing spondylitis) fulfilling New York criteria, was diagnosed in (62%) of the patients. There were more patients with radiographic axSpA in the earlier years of diagnosis (100% in 2015) and more of non-radiographic axSpA in the later years (83% in 2021). HLA-B*27 positivity was found in 79 (71.8%) of patients. The majority of referrals were from general practitioners 63 (57.2%), physiotherapists 19 (17.3%), orthopaedics 18 (16.4%) and other specialties 10 (9.1%). There was no significant difference in the mean (years) delay to diagnosis from the source of the clinic referral. The mean and median delay to diagnosis by year of diagnosis were 9.9, 9.5 (±3.1) years in 2015, 7.1, 7(±1) in 2016, 5.3,5 (±2.7) in 2017, 4.9, 4 (±3) in 2018, 4.4, 2.5 (±4.8) in 2019, 3.6, 2 (±3.2) in 2020, 2.2, 1 (±2.6) in 2021. The majority of the patients were diagnosed between 31-40 years (41%), 22% between 18-30 years, 31% between 41-50 years and 4% after the age of 50 years. Higher age at diagnosis was associated with a longer diagnostic delay. Diagnosis of disease at 18-30 years of age was associated with shorter mean delay to diagnosis (2.9 years), age 31-40 (4.6), age 41-50 (5.9), and age > 51 (6.5).

Conclusion

Delay in axSpA diagnosis has significantly improved in this real-world cohort during the last seven years. The mean diagnostic delay was 2 years indicating diagnostic delay may be for most patients shorter than previously reported. The factors associated with a faster diagnosis were a) more recent year of first rheumatology consult b) earlier age at presentation. Increased educational and awareness campaigns in primary care and musculoskeletal triage has led to the early recognition of axSpA. Early referral to a rheumatology service using electronic referral symptom can improve the diagnostic delay of axSpA. With continuous improvement cycles, our aim is to get reduce delays to diagnosis to under 1 year with line with the Gold Standard to Diagnosis in axSpA.

References

[1]All Party Parliamentary Group (APPG) on Axial Spondyloarthritis. 2019.

[2]https://nass.co.uk/wp-content/uploads/2020/03/APPG-on-Axial-SpA-Second-Meeting-Minutes.pdf

[3]NICE Guideline NG65. Spondyloarthritis in over 16s: diagnosis and management. 2017. https://www.nice.org.uk/guidance/ng65

Disclosure of Interests

Antoni Chan Speakers bureau: Janssen, Novartis, Amgen, Abbvie, Celgene, UCB, Consultant of: Novartis, Lilly, Abbvie, Grant/research support from: Novartis, UCB, Kathryn Rigler: None declared, Nadia Ahmad: None declared, Tanguy Lafont: None declared

The Effect of Layering Structures on Mechanical and Thermal Properties of Hybrid Bacterial Cellulose/Kevlar Reinforced Epoxy Composites

The effect of layering structures on mechanical and thermal hybrid bacterial cellulose (BC) sheet/Kevlar reinforced epoxy composites was investigated. The BC sheet was extracted from Nata de Coco and used as green reinforcement material hybrid with Kevlar reinforced epoxy composites. The BC/Kevlar reinforced epoxy composite was fabricated by using hand lay-up technique equipped with vacuum bagging system and the BC sheets and Kevlar layers were laminated into different layered structures. The performance of the hybrid BC/Kevlar reinforced epoxy composites was characterized through tensile test and low velocity impact according to ASTM D3039 and ASTM D7136, respectively. The thermal performance of the hybrid composites was characterized by using dynamic mechanical analysis (DMA) test. Tensile test on BC sheet composites with Kevlar and epoxy demonstrated that the addition of BC sheet in BC/Kevlar could not withstand the tensor stress by reducing the tensile stress and Young's modulus. The one layer of Kevlar which was replaced with three to six BC sheets had increased the ability to absorb impact force. The storage modulus (E′) and Tan δ were significantly dependent on the number of BC sheets and its layering structure. The highest value of E′ was observed when BC sheets were arranged alternately with the Kevlar layers. Different damage mechanisms associated with the number of BC sheets and its layered-structure suggested that the BC sheet was functioning as an impact energy absorber as well as strengthening fibers. This study will upsurge interest in BC reinforced composites and the development of new ideas in automotive, marine and bullet applications.

Dengue Early Warning System as Outbreak Prediction Tool: A Systematic Review

Early warning system (EWS) for vector-borne diseases is incredibly complex due to numerous factors originating from human, environmental, vector and the disease itself. Dengue EWS aims to collect data that leads to prompt decision-making processes that trigger disease intervention strategies to minimize the impact on a specific population. Dengue EWS may have a similar structural design, functions, and analytical approaches but different performance and ability to predict outbreaks. Hence, this review aims to summarise and discuss the evidence of different EWSs, their performance, and their ability to predict dengue outbreaks. A systematic literature search was performed of four primary databases: Scopus, Web of Science, Ovid MEDLINE, and EBSCOhost. Eligible articles were evaluated using a checklist for assessing the quality of the studies. A total of 17 studies were included in this systematic review. All EWS models demonstrated reasonably good predictive abilities to predict dengue outbreaks. However, the accuracy of their predictions varied greatly depending on the model used and the data quality. The reported sensitivity ranged from 50 to 100%, while specificity was 74 to 94.7%. A range between 70 to 96.3% was reported for prediction model accuracy and 43 to 86% for PPV. Overall, meteorological alarm indicators (temperatures and rainfall) were the most frequently used and displayed the best performing indicator. Other potential alarm indicators are entomology (female mosquito infection rate), epidemiology, population and socioeconomic factors. EWS is an essential tool to support district health managers and national health planners to mitigate or prevent disease outbreaks. This systematic review highlights the benefits of integrating several epidemiological tools focusing on incorporating climatic, environmental, epidemiological and socioeconomic factors to create an early warning system. The early warning system relies heavily on the country surveillance system. The lack of timely and high-quality data is critical for developing an effective EWS.

Post-Exposure Prophylactic Vaccination against Rabies: A Systematic Review

BACKGROUND

Post-exposure prophylaxis (PEP) is an effective method for preventing rabies, a highly fatal infection in exposed persons. Malaysia is currently using the purified Vero cell rabies vaccine (PVRV). Nonetheless, there are other commercially available vaccine types and regimens. This systematic review aimed at comparing the effectiveness of the different PEP vaccines, regimens and routes of administration among Asian populations.

METHODS

We systematically reviewed the PubMed and Web of Science databases for articles reporting on the effectiveness of PEP vaccination against rabies among Asian populations between 2015 and 2019.

RESULTS

Our search identified 11 relevant studies. Majority of study either used PCECV or PVRV type of vaccine, with different regimes and method. All are non-inferior to the other. Most of the studies recorded adequate response by Day 14 of vaccination. Nonetheless, the intradermal (ID) vaccination used minimal volume of vaccine used in all settings, thus cost less and the concurrent administration of RIG to the wound(s) doesn't affect the RVNA GMT response.

CONCLUSION

PCECV, using either the Essen or Zagreb regimen, might be a useful alternative for the healthy population in the context of PVRV shortage, especially during an outbreak. Use of the Zagreb or Thai Red Cross (TRC) regimens can be considered (either PVRV or PCECV), as both demonstrate good immunogenic outcomes in Asian populations.

Internet addiction and its association with depression, anxiety, and stress symptoms among allied health students in Malaysia

BACKGROUND Internet addiction (IA) is prone to be experienced by students and has become a major health concern. However, data on IA among allied health students are limited. This study aimed to describe the prevalence of IA and the association between mental health problems and IA among allied health students in Malaysia. METHODS A cross-sectional study was conducted from July to December 2021 in three government-funded allied health training institutes in Malaysia. A total of 265 allied health students undertaking a diploma in nursing, medical assistant training, physiotherapy, occupational therapy, and diagnostic imaging were recruited using stratified random sampling. The Malay version of the IA test was used to measure IA, while depression, anxiety and stress scale-21 items were used to assess their mental health problems. A general linear model was used to analyze the association between IA scores and mental health problems. RESULTS The prevalence of IA among allied health students was more than 80%, with 16.2% and 2.3% of them reporting moderate and severe IA, respectively. Higher depression (p<0.001), anxiety (p<0.001), and stress scores (p = 0.002) were associated with higher IA scores. CONCLUSIONS There were significant associations between mental health problems and IA scores among allied health students. Future studies with rigorous scientific methods are necessary to explore mental health effects on IA. Early intervention is also needed to prevent mental health problems among allied health students to overcome the problem of IA.

Acaricide resistance in Boophilus microplus ticks collected from two ecological Zones of Khyber Pakhtunkhwa, Pakistan

Boophilus microplus is a major cattle tick specie causing great economic loss to the dairy industry throughout the globe including Pakistan. Trichlorfon and Deltamethrin are used to control bovine ticks, and their sprays are also used in other pest control programs that exert pressure on ticks to gain resistance. This study is aimed to examine the resistance level of Rhipiciphalus microplus against trichlorfon and deltamethrin. The engorged ticks were collected from two ecological regions of Khyber Pakhtunkhwa, KPK Pakistan i.e., Swat & Dir (zone-1), and Charsadda & Nowshera (zone-2). Four concentrations of acaricides in two-fold and ten-fold ppm with three replicates for each were used in both bioassays. Egg hatch assay and adult immersion tests were used to assess the resistance status. The probit analysis of egg hatch assay showed the highest hatching percentage in zone 1 on both dilutions (67-76% on two-fold and 68-88% on ten-fold dilution) while lethal concentration (LC95) was found to be 2.187 ppm and discriminating dose (DD) as 4.374 ppm for trichlorfon. In zone 2, hatching percentage was 73-84 on two-fold and 72-91% on ten-fold dilution while LC95 was recorded as 0.599 ppm and DD as 1.198 ppm. The same parameters were studied for deltamethrin and in zone 1 the hatching percentage was found as 38-56% on two-fold dilution and 37-80% on ten-fold dilution while LC95 was recorded as 0.001 ppm and DD as 0.002 ppm. In zone 2, the hatchability was recorded as 42-58% on two-fold and 43-85% on ten-fold dilution. The values for LC95 was recorded as 0.001 ppm and DD as 0.002 ppm. Further, analysis of adult immersion test against trichlorfon revealed the values of LC50 as 2.85 ppm and LC95 as 4.71 ppm in zone 1 and in zone 2 as 3.14 ppm and 5.28 ppm, respectively. Similarly, LC50 and LC95 against deltamethrin was recorded as 0.79 ppm & 1.71 ppm in zone 1 and 0.45 ppm & 4.325 ppm in zone 2, respectively. Based on the findings of this study, the isolated Rhipicephalus microplus was found to be more resistant to the widely used acaricides i.e., trichlorfon than deltamethrin. In order to maintain the efficacy of acaricides at country level, the study recommends continuous monitoring of resistance.

Current e-cigarette use among in-school adolescents in West Malaysia: Examining the interactions between sociodemographic characteristics and lifestyle risk behaviours

Background

Adolescent e-cigarette use has increased dramatically. Most e-cigarette liquids contain nicotine, which can harm the developing adolescent brain. Local studies examining the risk factors of adolescent e-cigarette use and interactions between its risk factors are limited. This study was aimed at determining the prevalence of current e-cigarette use and its associated factors among in-school adolescents in West Malaysia. We also examined the possible sociodemographic characteristic, lifestyle risk behaviour and parental factor interactions that affect the probability of current e-cigarette use.

Methods

We conducted a cross-sectional study using data from the National Health and Morbidity Survey 2017. Respondents aged 13–18 years were included in the study. The data were analysed using STATA (v.15).

Results

The prevalence of current e-cigarette use was 9.1%. Male gender, older age, Malay ethnicity, schooling in urban area, current smoking, current alcohol use, current drug use, having parents that are not married and living together and parental tobacco product use were significantly associated with current e-cigarette use. There were significant interactions between: i) gender with age, ethnicity, current smoking, current alcohol use and current drug use, ii) ethnicity with current smoking and current alcohol use, iii) locality with ethnicity, current smoking and current alcohol use, iv) current drug use with age, ethnicity, current smoking and current alcohol use, v) parental marital status with gender, age and ethnicity, and vi) parental tobacco use with ethnicity and current smoking.

Conclusion

Our findings identify significant associations between sociodemographic characteristics, lifestyle risk behaviours and parental factors with current e-cigarette use. They also provide new insight into the interactions between these factors that affect the probability of current e-cigarette use among West Malaysian adolescents. Efforts to tackle e-cigarette use in Malaysian adolescents should target sociodemographic characteristics, lifestyle risk behaviours and parental factors such as smoking cessation intervention for parents.

The Malay-Version Knowledge, Risk Perception, Attitude and Practice Questionnaire on Heatwaves: Development and Construct Validation

Background: Heatwaves have long been recognised as a serious public health concern. This study was aimed at developing and validating a Malay-version of a questionnaire for evaluating knowledge, risk perception, attitudes, and practices regarding heatwaves. Method: The knowledge construct was evaluated with item analysis and internal reliability. The psychometric characteristics, construct and discriminant validity, and internal consistency of the risk perception, attitude and practice constructs were evaluated with exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Results: The 16 items in the knowledge construct had a good difficulty, discrimination, and reliability index of 0.81. A total of 16 items were maintained in EFA with Cronbach’s alpha of 0.84 and 0.82, 0.78 and 0.84 obtained for total items and risk perception, attitude, and practice constructs, respectively. A total of 15 items were retained after CFA. The finalised model met the fitness indices threshold. The convergent and discriminant validity were good. Conclusion: This newly developed Malay-version KRPAP questionnaire is reliable and valid for assessing Malaysians’ knowledge, risk perception, attitudes, and practices regarding heatwaves.

Seroprevalence of Hepatitis B Virus Infection and Its Associated Factors Among Blood Donors in Yemen

Background

In limited-resource countries, the prevalence of hepatitis B virus (HBV) infection can be measured using data taken from blood donors. This study aimed to determine the HBV infection seroprevalence and its associated factors among blood donors in Sana’a Governorate, Yemen.

Methods

A cross-sectional study was conducted on 500 people who donated blood at hospitals located in Sana’a between August and October 2016. The volunteers were aged 18–65 years old and were recruited using convenience sampling. A set of questionnaires was administered through face-to-face interviews. Blood samples from each donor were tested for hepatitis B surface antigens using enzyme-linked immunosorbent assay.

Results

The overall seroprevalence of HBV infection in the blood donors was 2.6%. Participants with a history of dental treatment had 7.80 higher odds (95% confidence interval [CI]: 2.26, 26.71; P = 0.002) for HBV infection. Respectively, blood donors who had history of malaria infection or cupping therapy had 7.48 (95% CI: 1.75, 31.82; P = 0.010) and 7.32 (95% CI: 1.72, 30.83; P = 0.010) greater odds of HBV infection.

Conclusion

The seroprevalence of HBV infection in Sana’a is lower than in other governorates in Yemen. Stakeholders could focus on a history of dental procedure, malaria infection and cupping treatment when strategising about HBV infection prevention and control among blood donors.

Effects of Se nanoparticles supplementation on growth performance, hematological parameters and nutrient digestibility of Labeo rohita fingerling fed sunflower meal based diet

The aim of the present study is to assess the effects of selenium nanoparticles on the growth, hematology and nutrients digestibility of Labeorohita fingerlings. Fingerlings were fed with seven isocaloric sunflower meal-based diet supplemented with different concentrations of nanoparticles naming T1 to T7 (0, 0.5, 1, 1.5, 2, 2.5, and 3 mg/kg), with 5% wet body weight while chromic oxide was used as an indigestible marker. After experimentation for 90 days T3 treated group (1mg/kg -1Se-nano level) showed the best result in hematological parameters (WBC's 7.97 ×103mm-3, RBC's 2.98 ×106 mm-3 and Platelet count 67), nutrient digestibility (crude protein: 74%, ether extract: 76%, gross energy: 70%) and growth performance (weight gain 13.24 g, weight gain% 198, feed conversion ratio 1.5, survival rate 100%) as compared to the other treatment groups. Specific growth rates were found significantly higher in T5 than in other groups. The present study indicated positive effect of 1 mg/kg Se-nanoparticles on growth advancement, hematological parameters, and nutrients digestibility of L. rohita fingerlings.

Coronary Heart Disease in Type 2 Diabetes Mellitus: Genetic Factors and Their Mechanisms, Gene-Gene, and Gene-Environment Interactions in the Asian Populations

Asians are more susceptible to type 2 diabetes mellitus (T2D) and its coronary heart disease (CHD) complications than the Western populations, possibly due to genetic factors, higher degrees of obesity, insulin resistance, and endothelial dysfunction that could occur even in healthy individuals. The genetic factors and their mechanisms, along with gene-gene and gene-environment interactions associated with CHD in T2D Asians, are yet to be explored. Therefore, the objectives of this paper were to review the current evidence of genetic factors for CHD, summarize the proposed mechanisms of these genes and how they may associate with CHD risk, and review the gene-gene and gene-environment interactions in T2D Asians with CHD. The genetic factors can be grouped according to their involvement in the energy and lipoprotein metabolism, vascular and endothelial pathology, antioxidation, cell cycle regulation, DNA damage repair, hormonal regulation of glucose metabolism, as well as cytoskeletal function and intracellular transport. Meanwhile, interactions between single nucleotide polymorphisms (SNPs) from different genes, SNPs within a single gene, and genetic interaction with environmental factors including obesity, smoking habit, and hyperlipidemia could modify the gene's effect on the disease risk. Collectively, these factors illustrate the complexities of CHD in T2D, specifically among Asians.

COVID-19 in Malaysia: exposure assessment and prevention practices among healthcare workers at a teaching hospital

INTRODUCTION

During the second wave of the coronavirus disease 19 (COVID-19) pandemic, Malaysia reported several COVID-19 clusters related to healthcare workers. Thus, addressing and understanding the risk of exposure in healthcare workers is important to prevent future infection and reduce secondary COVID-19 transmission within the healthcare settings. In this study, we aim to assess exposure and prevention practices against COVID-19 among healthcare workers at the Hospital Canselor Tuanku Muhriz, a university teaching hospital based in Kuala Lumpur, Malaysia.

METHODOLOGY

A total of 571 healthcare workers at COVID-19 and non-COVID-19 wards as well as the emergency department and laboratory staff at COVID-19 testing labs were recruited. The presence of novel human coronavirus (SARS-CoV-2) and IgM/IgG antibodies were confirmed in all healthcare workers. The healthcare workers responded to an online Google Forms questionnaire that evaluates demographic information and comorbidities, exposure and adherence to infection prevention and control measures against COVID-19. Descriptive analysis was performed using Statistical Package for the Social Sciences 24.0.

RESULTS

Three healthcare workers (0.5%) tested positive for SARS-CoV-2, while the remaining 568 (99.5%) were negative. All were negative for IgM and IgG antibodies during recruitment (day 1) and follow-up (day 15). More than 90% of the healthcare workers followed infection prevention and control practices recommendations regardless of whether they have been exposed to occupational risk for COVID-19.

CONCLUSIONS

The healthcare workers' high level of adherence to infection prevention practices at this hospital helped reduce and minimize their occupational exposure to COVID-19.

Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan

The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p 0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

Trend and pattern of melioidosis seropositivity among suspected patients in Malaysia 2015 - 2019

Melioidosis is a disease of public health importance associated with high case-fatality rates in animals and humans caused by Burkholderia pseudomallei (B. pseudomallei ), a gram- negative bacterium that lives in tropical soil environments. This study determined the seropositivity for melioidosis among patients admitted to healthcare centres in Malaysia, from 2015 to 2019 and identified factors related to it. A total of 26,665 serum samples of suspected melioidosis patients from Malaysia hospitals were tested for IgM against B. pseudomallei. About 16.4% of total samples were seropositive and majority of them were 55 years old and above. However, younger people aged less than 15 years old were the most susceptible to the infection (AOR 3.04, p <0.001, 95% CI: 2.73, 3.39). Melioidosis infection was the highest in Sarawak (15.1%) while Perlis was the least exposed to the infection (0.9%). Further analyses showed that patients with chronic lung disease (adjusted OR: 4.03, p < 0.001, 95% CI: 2.77, 5.86) were more susceptible to melioidosis infection. In conclusion, although serology testing is not a gold standard test in diagnosing melioidosis, it has been used as a tool in treatment monitoring and disease surveillance among patients and at-risk community in the endemic hot-spots regions.

The relationship of lifetime substance-use disorder with family functioning, childhood victimisation, and depression, among juvenile offenders in Malaysia

INTRODUCTION

Adolescent substance use is a multifactorial social issue that leads to detrimental outcomes. The aim of this study is to understand the association of a lifetime history of substance abuse or dependence with family functioning, childhood victimisation, and depression, among adolescent male inmates in a juvenile detention centre in Malaysia.

METHODS

This study was cross-sectional involving 230 inmates and was conducted in a juvenile detention centre in Malaysia. The mean age of the participants was 16.65 years, with the highest percentage from the Malay ethnicity (87.8% where n = 202). The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), Adolescent Alcohol and Drug Involvement Scale (AADIS), Family Adaptability and Cohesion Evaluation Scale (FACES) IV and Juvenile Victimization Questionnaire Second Revision (JVQ-R2) were used as instruments.

RESULTS

The prevalence of a lifetime history of substance abuse and substance dependence is 72.6% and 58.3%, respectively. A lifetime history of substance abuse and dependence had a significant association with age, race, religion, and peer/sibling victimisation. Further analysis reveals that an increase in age can be a predictor of both lifetime history of substance abuse and dependence while peer/sibling victimisation may predict lifetime history of substance abuse. There was no significant association of lifetime substance-use disorder with family functioning and depression in the juvenile offenders.

CONCLUSIONS

Adolescents exposed to peer/sibling victimisation might be at a higher risk of developing a substance-use disorder. At-risk groups need to be identified, assessed, and have intervention early to prevent adverse outcomes.

Pharmacological and non-pharmacological management of spinocerebellar ataxia: A systematic review

Spinocerebellar ataxias (SCA) comprise a rare, genetic subgroup within the degenerative ataxias and are dominantly inherited, with up to 48 recognized genetic subtypes. While an updated review on the management of degenerative ataxia is published recently, an evidence-based review focussed on the management of SCA is lacking. Here, we reviewed the pharmacological and non-pharmacological management of SCA by conducting a systematic review on Medline Ovid and Scopus. Of 29,284 studies identified, 47 studies (pharmacological: n = 25; non-pharmacological: n = 22) that predominantly involved SCA patients were included. Twenty studies had a high risk of bias based on the Cochrane's Collaboration risk of bias tool. As per the European Federation of Neurological Societies 2004 guideline for therapeutic intervention, the remaining 27 studies were of Class I (n = 4) and Class II (n = 23) evidence. Only two therapies had Level A recommendations for the management of ataxia symptoms: riluzole and immediate in-patient neurorehabilitation. Ten therapies had Level B recommendations for managing ataxia symptoms and require further investigations with better study design. These include high dose valproate acid, branched-chain amino acid, intravenous trehalose; restorative rehabilitation using cycling regimen and videogame; and cerebellar stimulations using transcranial direct current stimulation and transcranial magnetic stimulation. Lithium and coaching on psychological adjustment received Level B recommendation for depressive symptoms and quality of life, respectively. Heterogeneous study designs, different genotypes, and non-standardized clinical measures alongside short duration and small sample sizes may hamper meaningful clinical translation. Therefore, rating of recommendations only serve as points of reference.

The Impact of Meteorological Factors on Communicable Disease Incidence and Its Projection: A Systematic Review

Background: Climate change poses a real challenge and has contributed to causing the emergence and re-emergence of many communicable diseases of public health importance. Here, we reviewed scientific studies on the relationship between meteorological factors and the occurrence of dengue, malaria, cholera, and leptospirosis, and synthesized the key findings on communicable disease projection in the event of global warming. Method: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow checklist. Four databases (Web of Science, Ovid MEDLINE, Scopus, EBSCOhost) were searched for articles published from 2005 to 2020. The eligible articles were evaluated using a modified scale of a checklist designed for assessing the quality of ecological studies. Results: A total of 38 studies were included in the review. Precipitation and temperature were most frequently associated with the selected climate-sensitive communicable diseases. A climate change scenario simulation projected that dengue, malaria, and cholera incidence would increase based on regional climate responses. Conclusion: Precipitation and temperature are important meteorological factors that influence the incidence of climate-sensitive communicable diseases. Future studies need to consider more determinants affecting precipitation and temperature fluctuations for better simulation and prediction of the incidence of climate-sensitive communicable diseases.