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Aim To determine the proportion of non-compliance to iron chelation therapy (ICT) and its associated factors amongst patients with transfusion-dependent thalassaemia (TDT) in Malaysia. Methods A cross-sectional study was conducted amongst patients with TDT aged 9 years old and above, who were on iron chelation treatment, attending three tertiary hospitals in Kelantan and Terengganu. The socio-demographic, clinical and chelator history of patients were obtained. The compliance of patients to chelators was assessed using the Medication Compliance Questionnaire (MCQ). Social support was assessed using the Medical Outcome Study–Social Support Survey (MOS). Data was analysed using simple and multiple logistic regression. Results The proportion of non-compliance to ICT was 24.7%. Age, activity restriction and latest serum ferritin level of ≥1000 μg/L were significantly associated with non-compliance to ICT. Conclusion The non-compliance to ICT amongst patients with TDT in Kelantan and Terengganu is 24.7%. Providing motivational interview, enhanced self-empowerment of patients and psychological support are recommended to improve the non-compliance aspect amongst patients on ICT.

Common or external iliac artery injury due to blunt trauma is unusual without an associated pelvic fracture. Here we report on a 62 years old man that sustained left external iliac artery thrombosis due to blunt trauma following fall from motorbike. There was no immediate circulatory compromise. Contrasted CT of abdomen revealed an associated left lower abdominal wall traumatic hernia. The iliac artery was intervened with an endovascular stent to restore luminal flow and the hernia was repaired electively. The entire clinical course and management dilemma are described in this article.

Objectives: The primary and secondary objectives were to compare the glycaemic control and frequency of hypoglycaemia between continuous glucose monitoring system (CGMS) and self-monitoring blood glucose (SMBG). Methods: A single centre, randomised, parallel-group controlled trial was conducted involving twenty-two type one Diabetes Mellitus (T1DM) patients with the mean age of 13.8 years assigned to either intervention or control group. All respondents wore the CGMS device at the beginning of the study. Intervention group (n=11) had their insulin adjusted based on the CGMS data, while the control group (n=11) was based on SMBG. Monthly average blood sugar level (BSL) and monthly mean hypoglycemic events per week (HE/wk) were measured at baseline, first month, second month, and third month. HbA1c levels were measured at baseline and in the third month. Results: The baseline characteristics were similar. The data were analysed using repeated measure analysis of variance (ANOVA). The mean difference of HbA1c within the group was not statistically significant with p=0.322. There were significant differences in the monthly mean HE/wk within and between groups, p=0.004, and p=0.037. Conclusion: In conclusion, CGMS is equivalent to SMBG in optimising glycaemic control but is more effective in detecting hypoglycaemia in children.

Background: The condition of anemia in pregnant women in Indonesia is exacerbated by the habits of consuming tea. Anemia in pregnant women is still a health problem and a high-level cause of death that causes maternal bleeding indirectly. In Indonesia, tea is the most consumed beverage after water. The aroma of fragrant tea and its distinctive taste make this drink widely consumed. Tea can also be used as an antioxidant, improve skin, and slim the body. However, tea-drinking habits in pregnant women can affect the risk of anemia because tea contains tannins that can inhibit the absorption of iron. Purpose: To analyze the association between tea-drinking habits and anemia on pregnant women in Makassar, Indonesia. Methods: This was a quantitative study with cross-sectional design. The subject in this study was 36 pregnant women in the 2nd trimester of pregnancy that was chosen by accidental sampling. The analysis that used was chi-square test to examine the association between tea-drinking habits and anemia. A systematic questionnaire was used to collect data by interviewing respondents. Result: Of the 36 pregnant women who always drink tea, 22 respondents (48%) had anemia and 14 respondents (30%) were not anemic. Meanwhile, of 10 respondents who did not have tea consumption habits, 6 respondents (13%) had anemia and 4 respondents (9%) did not suffer from anemia. Chi-square test showed p=1,000 (p>0,05), which means that there was no association between tea consumption and anemia. Conclusion: Tea-drinking habit was not related to anemia in pregnant women in Makassar, Indonesia. Pregnant women may consume tea after eating but they need to control the interval, at least one hour after having a meal to avoid anemia.

Cardiovascular disease is the second highest cause of death across the globe. Myocardial infarction is one of the heart diseases that cause permanent impairment of the heart wall leads to heart failure. Cellular therapy might give hope to regenerate the damaged myocardium. Single cells isolated from an excess heart tissue obtained from the correction of the right ventricular hypertrophy in patients with Tetralogy of Fallot for future heart study were investigated. Methods: Once resected, the heart tissues were transported at 37 °C, in Dulbecco's Modified Eagle's medium/ DMEM (4.5 g.L−1, antibiotic–antimycotic 3x, PRP10% (v/v)), to reach the lab within 30 min, weighted and grouped into less than 500 mg and more than 1000 mg (n = 4). Each sample was digested with 250 U.mL−1 Collagenase type V and 4U.mL−1 Proteinase XXIV in the MACS™ C-tube (Milltenyi, Germany), then dissociated using the MACS™ Octo Dissociator with Heater (Milltenyi, Germany) for 60 min at 37 °C. Results: All cells isolated were rod-shaped cells; viability was up to 90%. The cell density obtained from the 500 mg group were 4,867 ± 899 cells.mg−1 tissue weight, significantly higher compared to the 1,000 mg group; had 557 ± 490 cells.mg−1 tissue weight (mean of (n = 3) ± 95% C.l). The isolated cells were analyzed using FACs BD Flowcytometer, expressed cTnT + 13.38%, PECAM-1 + /VCAM-1- 32.25%, cKit + 7.85%, ICAM + 85.53%, indicating the cardiomyocyte progenitor cells. Conclusion: Cardiomyocytes taken from the wasted heart tissue might be a candidate of cardiomyocytes source to study interventions to the heart as it contained up to 13.38% cardiomyocytes, and 32.25% of cardiac progenitor cells. Moreover, perhaps when cardiac cell therapy needs autologous cardiomyocytes, less than 500 mg tissue weight can be considered as sufficient.

Introduction: Chronic kidney disease (CKD) is kidney damage characterized by the presence of protein in the urine or a decrease in the glomerular filtration rate (GFR). CKD is a global problem throughout the world, including Indonesia, which requires special attention. IL-6 is known to play a role in regulating hemostatic functions, including glucose metabolism, the hypothalamus-pituitary-adrenal (HPA) axis, influencing mood, fatigue, depression, and hematopoiesis. As an inflammatory cytokine, IL-6 is an inflammatory mediator that most plays a role in various conditions, such as infection, autoimmune disease, and cancer. In CKD patients undergoing dialysis (HD), elevated serum IL-6 levels beginning from the start of the treatment is a strong predictor of mortality. The study aimed to determine the association between hemodialysis procedures and interleukin-6 levels in regular hemodialysis CKD patients in Haji Adam Malik Central General Hospital. Methods: This is an analytical study with a cross-sectional design. A total of 20 study subjects met the inclusion criteria and exclusion criteria, underwent history taking, physical examination, anthropometry, and laboratory examination to measure hemoglobin, creatinine, albumin, and IL-6 levels. Data analysis was performed using SPSS. Results: The median level of IL-6 before hemodialysis was 10.39 pg/mL with the lowest level and the highest level being 1.50 – 74.79 pg/mL, the median level of IL-6 after hemodialysis was 29.13 pg/mL with the lowest level and the lowest level. the highest is 2.11 – 316.20 pg/mL. Based on the results of the analysis, the levels of IL-6 after hemodialysis were higher than the levels of IL-6 before hemodialysis, there was a statistically significant relationship between regular hemodialysis and interleukin-6 levels before and after in patients with kidney disease. Conclusion: Regular hemodialysis and interleukin-6 levels have a statistically significant relationship before and after hemodialysis in CKD patients. Keywords: Chronic kidney disease; haemodialysis; interleukin-6.

Introduction: Sexual workers have been considered a core group for HIV and Sexual Transmission Diseases (STDs). Their risk is higher than women in the general population. As a developing country, Indonesia is no exception, where sexual transmission has become the main driver for the development of the epidemic in recent years. The survey result of Makassar's AIDS Eradication Commission in 2014 showed that the number of FSWs in Makassar increased. The high number of FSWs in Makassar affect the number of HIV/AIDS cases apparently. Method: This study used data from a rapid survey conducted by Makassar AIDS Eradication Commission in 2013. The survey was carried out to gain information about the sexual behaviour of FSWs in Makassar. The number of sample was 240 in which sampling was carried out using the C-Survey program system. A systematic questionnaire was used to gather data from FSWs, and data was analyzed by using STATA program. Result: Most of the FSWs in this study are aged between 36-40 years old (27.9%). For the last sexual intercourse, most of the FSWs offered a condom to their clients (85.0%). However, the number of clients who used a condom for intercourse was lower that is 77.5%. The main reason why clients refuse to use a condom is that they are uncomfortable. Conclusion: The awareness of FSWs to offer a condom is higher than the willingness of clients to use a condom consistently. Keywords: Sexual Behaviour; Condom Use; Female Sexual Workers; Makassar.

The prevalence of GERD has continued to increase in Asian countries in recent decades. The incidence of overweight and obesity continues to increase. Many studies have revealed that obesity in general or abdominal obesity causes a significant increase in the risk of GERD symptoms. The research objective was to determine the relationship between BMI and waist circumference with the incidence of GERD in the adult population of Palembang city.An analytic observational with a cross-sectional design. The population were all adults(≥20 years) of Palembang. The number of samples were 400 people. Data were taken from a self-completed questionnaire, distributed through various social media, then analyzed using logistic regression analysis.Among 400 subjects in the study, there were 81 subjects (20.3%) diagnosed with GERD, 43 subjects (10.8%) were overweight, 79 subjects (19.8%) were obese, and 160 subjects(40%) have had abdominal obesity. There was a significant relationship between obesity and diagnosis of GERD (p=0,001; OR =2,799; CI95% = 1,545-5,069). In contrast, there were no significant relationship between overweight and diagnosis of GERD. There were also no significant relationship between abdominal obesity and diagnosis of GERD. Obesity has a significant association with the diagnosis of GERD, but the absence of an association between overweight and diagnosis of GERD implies that increased BMI is not an independent risk factor in diagnosis of GERD.

Yaws is a rare skin disease endemic to tropical countries caused by Treponema pertenue. It is highly infectious and spreads through physical contact. In Malaysia, it was presumably eradicated during the 1960s, with the last reported case published in 1985. Due to its rarity, the disease often goes unrecognised and misdiagnosed. Here, we report the case of a 5-year-old aboriginal boy diagnosed with secondary yaws who presented with fever and an incidental finding of chronic painless ulcerated nodules and plaques on his lower limbs and gluteal region. His diagnosis was confirmed serologically with a venereal disease research laboratory lab test and he was successfully treated with a single dose of intramuscular benzathine penicillin G. Primary care physicians should not ignore this disease since its early recognition and appropriate treatment is vital to its eradication, especially in high-risk communities.

BACKGROUND: Hyaluronic acid (HA) is an essential component of extracellular matrix and mediates signaling in wound healing. HA could induce growth factor release from Advanced Platelet Rich Fibrin (A-PRF), including Vascular Endothelial Growth Factor (VEGF) and Platelet-derived Growth Factor (PDGF). However, concentrations of the released-VEGF and PDGF have not been clearly disclosed. Therefore, current study was conducted to measure the release of these growth factors in HA + A-PRF gel of diabetic foot ulcer (DFU) subjects. METHODS: Twenty DFU subjects were included in the study and treated with A-PRF or HA+A-PRF. A-PRF was derived from autologous peripheral blood and processed with low-speed centrifugation. HA was added with a ratio of 1:0.6. A-PRF or HA + A-PRF was applied topically on DFU. Upper tips of A-PRF or HA + A-PRF gels were collected on day 0, 3 and 7 for measurements of VEGF and PDGF concentrations with Enzyme-linked Immune-sorbent Assay (ELISA) methods. RESULTS: On day-3, both VEGF and PDGF concentrations of HA + A-PRF group were significantly higher than the VEGF ( p =0.000) and PDGF ( p =0.019) concentrations of A-PRF group. The VEGF and PDGF concentrations were continuously and significantly increased on day-7 of HA + A-PRF group, compared to the VEGF ( p =0.000) and PDGF ( p =0.004) concentrations of A-PRF group. CONCLUSION: Combination HA+A-PRF induces VEGF and PDGF release from A-PRF. A mixture of A-PRF and HA could be more effective than A-PRF alone for treatment of DFU. KEYWORDS: hyaluronic acid, advanced platelet rich fibrin, PRF, growth factor, VEGF, PDGF, diabetic foot ulcer

Background: One of the modalities of renal replacement therapy in chronic kidney disease (CKD) is hemodialysis (HD). The role of inflammation in HD patients by uremic toxins and dialysis can be assessed by the marker of serum albumin. This inflammation also causes dysregulation of the hormone erythropoietin which results in increased variability or heterogeneity of red blood cell distribution width (RDW). Previous studies have revealed an association between RDW and albumin levels in regular HD patients which leads to increased patient morbidity and mortality. This study aims to determine the relationship between albumin serum levels and RDW as a marker of inflammation in regular HD patients. Method: This was a cross sectional study design, conducted in June to August 2020 at the HD unit of Haji Adam Malik General Hospital in Medan. Twenty subjects were included. Data were analyzed using Pearson correlation test and T-test to find the correlation between albumin serum levels and RDW, and other variables. Results: Of the 20 subjects taken based on consecutive sampling, the majority was male, 13 people (65%), mean age was 50.30 ± 12.57 years with the most comorbid type 2 diabetes mellitus for 14 people (70%). The mean serum albumin level was 3.2 ± 0.65 mg/dl. The mean RDW value was 15.93 ± 1.87%. This study showed that there was a significant relationship between serum albumin levels and RDW values ​​(r = - 0.687; p = 0.001). RDW values ​​were also significantly associated with hemoglobin levels (r = 0.497; p = 0.026) and creatinine (r= 0.519; p= 0.019). Conclusion: Albumin, hemoglobin, and creatinine levels were significantly associated with RDW values ​​in regular HD patients. Keywords: inflammation, albumin, regular hemodialysis, RDW.

Insomnia is a common health problem in the elderly. The aging process causes a decrease or change in physical and psychological conditions, thereby increasing sleep latency, decreasing sleep efficiency, and waking up earlier. This study aims to determine the effect of murottal Al-Qur'an therapy on reducing insomnia levels in the elderly. Murottal Al-Qur'an therapy is one of the healing methods that can reduce stress hormones and increase endorphins, thereby increasing feelings of relaxation and happiness. This study used a one-group pretest-posttest design. Data analysis used paired T test. The population in this study were elderly people who experienced insomnia of ​​Puskesmas Usuku Wakatobi with a sample of 30 people (15 people in the control group and 15 people in the intervention group). The control group was not given therapy while the intervention group was given therapy. Insomnia level measurements before (pretest) and after therapy (posttest) were carried out in both groups. The results of the study using the paired t test showed that the provision of Al-Qur'an murottal therapy can reduce the level of insomnia in the elderly by a significant level of 5%. Murottal Al-Qur'an therapy can reduce the number of insomnia sufferers to 5 people (33%) mild insomnia and 10 people (67%) recovered from insomnia. Whereas in the control group, there was no significant reduction in insomnia levels. It can be concluded that, giving murottal Al-Qur'an therapy with Surah Al-Rahman can reduce insomnia levels in the elderly in the working area of ​​Puskesmas Usuku Wakatobi.

Objective: To assess the correlation between BDI II score as screening tools for early symptoms of depression with serum magnesium levels in regular hemodialysis patients. Methods: A cross-sectional study conducted on 48 patients with chronic kidney disease on regular HD in RSUP Haji Adam Malik. Patients included in this study were ≥ 18 years of age, on regular HD with a duration of ≥ 3 months, and were willing to be included in the study by signing a consent form after explanation. Patients with other psychiatric comorbidities other than depression and patients taking medicine that affect serum magnesium levels were excluded from the study. All studied patients were assessed for serum magnesium levels and depression symptoms using the BDI II questionnaire. Results: In this study we found that there is a significant correlation between serum Magnesium levels and BDI II score with a weak correlation strength level (r = - 0.35). The BDI II score in regular hemodialysis patients was found to be in a score of 4-15 with a median score of 7. Magnesium levels in regular hemodialysis patients ranged from 1.78 to 3.75 mg / dl, with a median of 2.9. Conclusions: In this study, there is a significant correlation found between serum Magnesium levels and BDI II score in patient on regular HD. Keywords: Beck Depression Inventory II (BD II) score, Chronic Kidney Disease, Hemodialysis, Serum magnesium levels.

Background: Chronic kidney disease (CKD) is characterized by structural and functional disorder of the kidney with irreversible and gradual characteristics with one of the modalities of renal replacement therapy such as hemodialysis (HD). The role of inflammation in HD patients by uremic toxin and dialysis can be assessed by the marker of High Sensitive C Reactive Protein (HsCRP). Several studies have examined the relationship between HsCRP and red cell distribution width (RDW) in regular HD patients which leads to increase patient morbidity and mortality, but until now, there has been no study in Indonesia regarding the correlation between HsCRP and RDW in regular HD patients. This study aims to determine the correlation HsCRP as a marker of inflammation and RDW values in regular HD patients. Methods: This is a cross-sectional study in Regular HD patients at Dialysis Unit-H. Adam Malik General Hospital. A total of 20 subjects were included. Bivariate and multivariate analysis was conducted to analyze the relationship of HsCRP, ureum, creatinin, hemoglobin, and eGFR to RDW. Results: There were 20 Regular HD patients analyzed. The proportion of patients with increased RDW was 80%. In pearson correlation test, there is a strong correlation between HsCRP and RDW (r= 0.667, p

BACKGROUND: Diabetic foot ulcer (DFU) is the most common and threatening complication of Diabetes Mellitus (DM). Ideal wound dressing for DFU management should relieve symptoms, provide wound protection, and encourage healing. Advanced-Platelet Rich Fibrin (A-PRF) and Hyaluronic Acid (HA) have been proven to improve wound healing process. This study was aimed to demonstrate the ability of combination of A-PRF and HA in reducing inflammation and improving DFU tissue healing. METHODS: Twenty DFU subjects were involved in this study, and divided into two groups based on the topical fibrin gel treatment: A-PRF + HA group and A-PRF only group. A-PRF was obtained by peripheral blood centrifugation. A-PRF + HA was prepared by homogening A-PRF and AH with a ratio of 1:0.6. Interleukin-6 (IL-6) level, granulation index (GI), numeric pain score (NPS), and inflammation clinical symptoms (ICS) were assessed on day-0, 3, 7 and 14. RESULTS: Wound swabs’ IL-6 level on day-7 was found to be significantly lower in A-PRF + HA compared to A-PRF alone ( p =0.041). The IL-6 level reduction also found to be significant higher either in wound swabs (day 0-7, p =0.015) or fibrin gel (day 0-3, p =0.049; day 0-7, p =0.034). A-PRF + HA treatment significantly increased the GI even since day-3 ( p =0.043), with lower NPS ( p

BACKGROUND AND AIMS: Body mass index (BMI) has previously been shown to increase mortality and disease severity in patients with COVID-19, but the pooled effect estimate was heterogeneous. Although BMI is widely used as an indicator, it cannot distinguish visceral from subcutaneous fat. This systematic review and meta-analysis aimed to investigate the association between visceral adiposity, subcutaneous fat, and severe COVID-19. METHODS: We performed a systematic literature search using the databases: PubMed, Embase, and EuropePMC. Data on visceral fat area (VTA), subcutaneous fat area (SFA), and total fat area (TFA) were collected. The outcome of interest was severe COVID-19. We used a REML random-effects model to pool the mean differences and odds ratio (OR). RESULTS: There were 5 studies comprising of 539 patients. Patients with severe COVID-19 have a higher VTA (mean difference 41.7 cm2 [27.0, 56.4], p

This study aims to model stunting cases in children under five in Gorontalo city in 2018. In this model, it can be seen that the significant factors that affect stunting cases in children under five in Gorontalo city in 2018. This study uses data on stunting cases in 9 (nine) districts in the city of Gorontalo and the factors that influence it. The research data were obtained from the Public Health in Gorontalo city. This study used one response variable, namely the number of cases of stunting and four predictor variables, namely number of toddlers who received exclusive breastfeeding, the percentage of low birth weight (LBW), the percentage toddlers who received complete basic immunization, and number of proper sanitation. The results obtained were the variables of number of toddlers who received exclusive breastfeeding and the percentage toddlers who received complete basic immunization which had a significant effect on stunting cases in children under five in the city of Gorontalo in 2018. This was indicated by the P-value of the variable for number of toddlers who received exclusive breastfeeding of 0.00283 and P-value of variable the percentage toddlers who get complete basic immunization is 0.06564.

Purpose – Mucosal lesions of the oral cavity are common findings at dental clinic worldwide. Regardless of the severity and diagnosis, oral mucosal lesions (OMLs) affect an individual’s general health, as the oral cavity serves as the main route for nutrients intake that is crucial for human survival. Data on the prevalence and distribution of OMLs is imperative to aid in the diagnosis and management of OMLs. The aim of the present study was to determine the distribution of OMLs amongst patients attending dental clinic, Hospital Universiti Sains Malaysia (Hospital USM). Design and methodology - A cross-sectional study using secondary data was conducted. Dental records of patients receiving oral examination and treatment in dental clinic from January to December 2014 were obtained. Data were analysed using Chi-square test. Throughout 2014, 43 records of patients presented with OMLs were obtained. Findings - The most common lesion was ulcerative lesions (37.3%), followed by oral lichen planus (27.4%). Patients with exophytic lesions contributed 15.7%, while candida-related lesion and keratotic lesion contributed 11.8% and 7.8% respectively. Except for keratotic lesion, which was significantly associated with smoking, none other OMLs were associated with any of the risk habits (smoking, betel quid chewing or alcohol consumption). Originality/Value - Data from this study serve as a basis for OMLs epidemiology studies on larger scale that will further aid in the detection, diagnosis and better management of the oral lesions. Findings from this study further emphasize the importance of quit-smoking program to reduce the risk of developing oral keratotic lesion, among other diseases that have been associated with smoking habit.

Air is one of the most important elements of life for living things in the world. For humans, the air is an element that is very concerned because it is related to health. In Jakarta, the Air Pollution Standard Index (ISPU) is ranked second as the capital city of a country with poor air quality. Air quality in Jakarta is monitored by an Air Quality Index (AQI) of 160 with parameters in the form of very small pollutant particles with a diameter of fewer than 2.8 micrometres (PM 2.8). The purpose of this research is how we make a tool that can determine the quality of the air around us and can be carried (portable) anywhere easily. In accordance with the 4.0 industrial revolution that everything has been integrated with the Internet of Things (IoT) technology where the public can find out the air condition in real-time. In this study, the prototype method is used as a test. The main components are sensors consisting of MQ-6 (CO2 and smoke), MQ-7 (CO, LPG, CH4), MQ135 (Butane, AirQuality), and DHT-11 (Humidity, temperature). From the research that has been done where the air quality in urban areas has a low air quality index by measuring it using a prototype consisting of a gas sensor and Arduino microcontroller, which has been made to produce an average CO2 of 25 ppm, CO 2330 which has exceeded the threshold, while NH3 1.23 and C4H10 1120 are still below the threshold. These values are influenced by pollutants generated by transportation such as motorbikes, cars, and land transportation

Cardiovascular diseases play major roles in the health problems worldwide especially in Indonesia. Percutaneous coronary intervention (PCI) is a minimally invasive procedure with relatively low complications. However, high inflammatory response post-PCI has showed adverse events even after administration of standard medication. Previous studies showed that curcumin was able to reduce inflammatory response in adult patients with stable coronary heart disease (CHD). This article determines the efficacy of oral administration of curcumin in reducing inflammatory response post-PCI with stable CHD. A double-blind randomized controlled trial on 50 adult patients comparing curcumin and placebo was performed in Cipto Mangunkusumo General Hospital and Jakarta Heart Center within April and June 2015. Either curcumin (45 mg/day) or placebo was given 7 days prior to PCI until 2 days after PCI. Inflammatory markers (high-sensitivity C-reactive protein [hsCRP] and soluble CD40 ligand [sCD40L]) were measured in three phases (7 days prior PCI, 24 hours post-PCI, and 48 hours post-PCI). There were no significant differences in the reduction of hsCRP and sCD40L between curcumin and placebo groups in three phases of measurement. Curcumin significantly reduce the serum hsCRP (p = 0.006) and sCD40L (p = 0.002) 7 days before PCI to 48 hours post-PCI. The decrement of hsCRP (−14.2% vs. –7.4%) and sCD40L (−24.3% vs. –13.2%) from 24 to 48 hours post-PCI was higher in the curcumin group than placebo group. The administration of curcumin 45 mg dose daily for 7 days prior PCI until 48 hours post-PCI is useful in reducing inflammatory response post-PCI with stable CHD.

Plantation-grown, high-value timber species producing high-value end products are key to optimising land utilisation in Sabah and Sarawak states in Borneo, Malaysia, while meeting the demand for do...

Objectives:The present study aims to develop and test the effectiveness of a “HeartBEAT” Adolescent Transition Psychoeducation Program (ATPP) in facilitating the well-being of adolescents who have been diagnosed with congenital heart defects (CHD).Methods:The HeartBEAT ATPP was developed after reviewing existing transition interventions and determining adolescents’ needs. It was based upon two theories, namely the Shared Management Model and Antonovsky’s Salutogenic Model and included five aspects: (i) knowledge on illness and treatments, (ii) self-management and transition skills, (iii) purpose of life, (iv) social support, and (v) emotional regulation skills. Mixed-methods pilot testing was then conducted. Paired t-test was used to explore the effectiveness and qualitative interviews were also conducted.Results/Conclusions:Fourteen patients aged 16–19 enrolled in this study, but only eight patients successfully complete the programme. Results showed that a paired t-test was conducted to determine its effectiveness. Results showed that the programme had significantly increased self-management knowledge (t (7) = −6.328, p < 0.05) and affectionate support (t (7) = −1.029, p < 0.05). Qualitative findings also showed that all patients were able to share emotional regulation and identify their purpose of life after the programme. However, there was no significant increase in their self-management skills. In summary, the “HeartBEAT” ATPP has demonstrated efficacy in enhancing self-management knowledge, affectionate support, identifying the patients’ life plan, and enhancing the emotional regulation skills of the adolescents with CHD.

The flood disaster in Kelantan in 2014 had resulted in substantial health implications including increased cases of communicable diseases. There was a lack of community preparedness including customized health educations in the prevention and control of flood-related communicable diseases in the affected areas. The research was aimed to evaluate the effectiveness of community-based health education modules on flood-related communicable diseases among communities in Kelantan. Health education modules focusing on major food-related diseases were developed. A non-randomized community-controlled trial using the modules were conducted. Outcomes were assessed on knowledge, attitude and preventive practice scores to flood-related communicable diseases using a pre-validated questionnaire. Independent t test was used to compare mean scores between the intervention community (Tumpat) and the control community (Bachok) at 1-month post intervention. One-way independent ANOVA test was done to compare score differences at baseline (pre), post 1-month and post 2-month from repeated surveys among random samples within the intervention community. There were significant improvements in all knowledge components from 9.4% to 52.6% with 10% increment in attitude scores toward preventing behaviours on flood-related communicable diseases. When compared against the control community at one-month post-intervention, there were significantly higher knowledge on types of diseases, symptoms and risk factors as well as practice scores of drinking safe water and protective habits. This research demonstrated that community-based health education is effective in improving relevant knowledge, attitude and preventive practices among affected communities as part of their preparedness toward communicable diseases related to flood.

Background: The Malaysian Breastfeeding Peer Counselor Association (MBfPCA) is a pioneer non-governmental organization (NGO) of trained breastfeeding peer counselors in Malaysia. We explored the effect of peer counseling support on breastfeeding outcomes among postnatal mothers who delivered at a national tertiary teaching hospital and their satisfaction with the peer counseling services.Method: A total of 210 postpartum mothers were recruited in a single-blinded, randomized, controlled trial. Block randomization was used to allocate the participants into the intervention (I) group (n=105), who received telephone-based peer counseling support at 72 hours, 2 weeks, 1, 2, 4 and 6 months postpartum; and the control (C) group (n=105), who received routine breastfeeding advice. The infant feeding practices information was obtained at 2, 4 and 6 months postpartum from both groups. Data on maternal satisfaction with peer counseling services was acquired from the intervention group participants 6 months postpartum.Results: Ninety-four mothers were lost to follow up, leaving 116 (I=60, C=56) for analysis. The number of participants who practiced exclusive breastfeeding was higher in the intervention group at all intervals, with significant difference seen at 6 months postpartum (p = 0.035). Significant differences were also seen in the prevalence of breastfeeding between the groups at 4 and 6 months postpartum (p = 0.017 and p = 0.010). All participants who practiced exclusive breastfeeding found that peer counselors helped them reach their breastfeeding goals (p =0.001) and would recommend peer counseling services to others (p = 0.037).Conclusion: Peer counselor support in Malaysia increased the duration and exclusivity of breastfeeding and was well accepted among postnatal mothers.

Background. Red cell distribution width (RDW) is a coefficient of variation in red blood cells that can decrease erythropoesis or increase the destructiveness of red blood cells. The objectives of research to determine the relationship of RDW as an inflammatory marker with renal function and hematological parameters in patients undergoing regular hemodialysis Method; Cross sectional research on 20 patients undergoing regular hemodialysis > 3 months in RSUP H Adam Malik Medan. Vital sign, antropometry and venous blood retrieval are performed shortly before hemodialysis. RDW measurement comes from the red blood cell distribution curve in hematological analysis and is an indicator of variation in red blood cell size. Result: out of 20 subjek studies, there were 13 men (65.0%) and 7 (35.0%) women The majority of subjects had comorbid diabetes mellitus 14 (70.0%), hypertension 4 (20.0%). The average length of time patients underwent hemodialysis was 24.45 ± 20.98 months. There is a significant correlation between RBW and creatinine, Hb, and neutropil (r: 0.519, p:0,019*; r: 0.497, p: 0.026*;r: 0.464, p: 0.039*, respectively) Conclusion: There is a significant relationship between RBW and creatinine, Hb and neutropphils in patients undergoing regular hemodialysis > 3 months.

Purpose One of the most frequent causes of cardiac mortality is ST elevation myocardial infarction (STEMI). Delay in the management of STEMI patients is a cause of high mortality and morbidity. This study aims to determine the effect of the implementation of the CODE STEMI program on major adverse cardiac events (MACE) and mortality of STEMI patients at Dr. Cipto Mangunkusumo General Hospital. Patients and Methods This was a retrospective cohort study that enrolled 207 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) in 2015-2018. The patients were divided into two groups. The first group was treated prior to establishing the CODE STEMI program. The other group was treated according to the program, which was implemented in January 2017. Data were collected from medical records, and we retrospectively analyzed all in-hours, MACE, and mortality of STEMI patients from both groups as primary outcomes. Data analysis was done using the Mann-Whitney and chi-square test. Results There were 72 and 135 patients in the pre-CODE STEMI and CODE STEMI groups, respectively. D2BT was significantly reduced by 130 min (288±306 vs 158±81, P< 0.001) since the implementation of CODE STEMI program. There were trends to lower in-hospital mortality rates (8.3% vs 4.4%, RR = 0.53) and MACE at 30 days (48.61% vs 37.78%, RR = 0.77). Conclusion Implementation of the CODE STEMI program can reduce door-to-balloon time and decrease the MACE and mortality rate in STEMI patients in general hospitals.

Background and aims COVID 19 pneumonia commonly leads to ARDS. The occurrence of ARDS in COVID 19 patients is thought to occur secondary to an exaggerated immunologic response. In this meta-analysis, we aim to comprehensively study the various levels of immunological parameters in patients with COVID 19. Materials and methods We performed a systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and medRxiv with the search terms, “COVID-19” and “Interleukin”. The outcome of interest was prognosis in COVID 19 patients. Results We performed meta analysis of 16 studies. Higher counts of CD4 and CD8 with Lower Levels of TNF-a, IL2R, IL6, IL8 were observed on patients with good prognosis compared to patients with poor prognosis; −0.57 (pg/mL) (−1.10, −0.04, p = 0.04), (I2 91%, p, Highlights • Elevated immune response occurs in COVID 19 patients, and this immune response is mediated by various cytokines. • Exaggerated immune response in COVID19 does not seem to be mediated by complements. • Wider gap in IL-6 levels are observed between older age patients with good and poor outcomes. • Lower levels of TNF-a, IL6, IL8, and IL10 were observed in patients with good prognosis.

Currently, alternative chemical methods that produce less adverse effects on the environmentare being explored to replace the conventional chemical methods. One example is the use of green solvents to replace the conventional hazardous solvents that are used extensively in industry. Palm oil contains vegetable oil which has many types of small components such as carotenoids, which have a natural source of provitamin A and are able to supply a relatively expensive source of vitamin A. Carotenoid compounds related to palm oil are useful ingredients for users who are sought by antioxidants. In this study, carotenoids in palm oil was extracted using a solvent extraction method with methanol and a Deep Eutectic Solvent (DES) as a co-solvent. DES which used was DL-Menthol-based DES as a Hydrogen Bond Donor (HBD) and acetic acid and lauric acid as Hydrogen Bond Acceptors (HBA) which were reacted with 1: 1 and 2: 1 molar ratios. DES was formed in the characterization of its physicochemical properties which include: Viscosity, Density and pH while characterization of the functional groups using FTIR. The optimum conditions for carotene extraction in this study were 212.7 ppm using DES MLA, while for the concentration of β-carotene obtained 0.156 ppm. These results showed that the DES solvent as a co-solvent can increase the yield of carotene extraction in crude palm oil.

Background: Restless Legs Syndrome (RLS) is one of the most common sleep disturbance problems in dialysis patients. In this study, we would like to explore some of bone and mineral marker disorder especially fibroblast growth factor-23 (FGF-23)and its correlation with RLS in regular hemodialysis patients. Methods: This is a cross sectional study design involving 71 respondents with chronic kidney disease that already had regular hemodialysis at Haji Adam Malik Hospital Medan. Status of RLS in this patients were being evaluated according to the International Restless Leg Syndrome Study Group (IRLSG) by interviewing and laboratory examination of FGF-23, hemoglobin (Hb), serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TSAT), serum ferritin, calcium (Ca) and phosphate (P) level. Results: Of all study subjects, 26 respondents (34.6%) diagnosed with RLS. Bivariate analysis result showed that there is a relationship between FGF-23, hemoglobin, phosphate, and transferrin saturation level with RLS. Logistic regression analysis used to see the most dominant factor of all. Conclusion This study conclude that increase in FGF-23 levels can increase the risk of RLS. However, FGF-23 is not the most dominant risk factor for RLS in regular hemodialysis patients.

Streptococcus mutans is a Gram-positive facultative anaerobic bacteria which has become the main cause of dental caries. Black pepper (Piper nigrum L ) is one of herbal plants that compose antibacterial compounds including alkaloids, flavonoids, tannins, and essential oils. This study aims to determine the effect of black pepper (Piper nigrum L.) extract to inhibit of Streptococcus mutansgrowth. Black pepper extracts ware made by using maceration method. The effect of black pepper extract ( Piper nigrum L. ) in inhibition of Streptococcus mutansgrowth by using the disc diffusion method on Mueller Hinton Agar media. The concentration of black pepper ( Piper nigrum L.) extracts used in this study were 6.25%, 12.5%, 25%, 50%, 75%. The results of this study were analyzed by using the one-way ANOVA test showed that there was significant effect of black pepper extract on Streptococcus mutans growth with p-value (p

Introduction Xmn1-Gγ polymorphism has been significantly associated with disease severity in HbE/β-thalassemia patients. The aim of this study is to determine the factors affecting health related quality of life (HRQoL) and its association with Xmn1-Gγ polymorphism among transfusion-dependent β-thalassemia and HbE/β-thalassemia adolescents. Materials and Methods A cross-sectional study was conducted from day care thalassemia centers and thalassemia clinics of tertiary centers in East Coast Malaysia. The Malay version of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scale was used to evaluate quality of life. Associated factors were analyzed using multivariate regression analysis. Results The lowest QoL mean score was school functioning at 59.69 (16.23). Xmn1-Gγ polymorphism was significantly associated with physical functioning (p = 0.018) and emotional functioning (p = 0.013). Frequency of blood transfusion per year was found to be significantly associated with social functioning (p = 0.005) while gender and age onset of anemia were significantly associated with school functioning (p = 0.009 and p = 0.009). Xmn1 heterozygous CT was significantly associated with a higher physical functioning score by 0.192 and a higher emotional functioning score by 0.202 compared to Xmn1 homozygous wild-type CC. It is reportedly significantly higher concentration of HbF in patients with a “T” nucleotide change at the -158 locus at the Gγ-globin promoter compared to those without the polymorphism. Conclusion The precise factors that influence HRQoL empowers a better understanding to the effectiveness of thalassemia disease management in the country.

Developmental delay, Epilepsy and Neonatal Diabetes (DEND) syndrome is the most severe form of Permanent Neonatal Diabetes with KCNJ11 gene mutation which accounts for most of the cases. We report the first DEND syndrome in Malaysia with heterozygous missense mutation Q52R at KCNJ11 (Kir6.2) gene with delayed presentation beyond 6 months of age and failure to transition to glibenclamide. This report signifies the phenotypical variability among patients with the same genetic mutation and the different response to treatment.

OBJECTIVES This study aims to review our institutional experience of ductal stenting (DS) on the growth of pulmonary arteries (PAs) and surgical outcomes of PA reconstruction in this subset of patients. METHODS This is a retrospective study done in neonates and infants up to 3 months of age with duct-dependent pulmonary circulation who underwent DS from January 2014 to December 2015. Post-stenting PA growth, surgical outcomes of PA reconstruction, post-surgical re-interventions, morbidity and mortality were analysed. RESULTS During the study period, 46 patients underwent successful DS, of whom 38 underwent presurgery catheterization and definite surgery. There was significant growth of PAs in these patients. Biventricular repair was done in 31 patients while 7 had univentricular palliation. Left PA augmentation was required in 13 patients, and 10 required central PA augmentation during surgery. The mean follow-up period post-surgery was 4.5 ± 1.5 years. No significant postoperative complications were seen. No early or follow-up post-surgery mortality was seen. Four patients required re-interventions in the form of left PA stenting based on the echocardiography or computed tomography evidence of significant stenosis. CONCLUSIONS DS provides good short-term palliation and the growth of PAs. However, a significant number of stented patients require reparative procedure on PAs at the time of surgical intervention. Acquired changes in the PAs following DS may be the reason for reintervention following PA reconstruction.

Therapeutic communication is one of the important keys in providing patient services in hospitals. Nurses who have communication skills, not only will easily establish a relationship of trust with patients, also prevent illegal problems, and increase satisfaction in the hospital. This study aims to analyze the effect of nurses' therapeutic communication with patient satisfaction in the inpatient installation at Massenrempulu District Hospital Enrekang. The method used is this research is an observational analytic with cross sectional study design. The population in this study were patients in the inpatient hospital of Massenrempulu District Hospital. The research sample of 75 people. The technique of determining the sample is to use the accidental sampling method. Analysis of the data used is chi square and multiple logistic regression. The results showed that the majority of respondents aged 40-49 years (25.3%), were female (61.3%), had elementary / equivalent education (30.7%) and worked as farmers (36.0%). The analysis showed that there was a statistically significant relationship between the variable respect (0.002), positive attitude (0.019) and not a meaningful relationship opening up (0.239) with patient satisfaction. The results of multivariate analysis with multiple logistic regression tests showed that the positive attitude of Exp (B) or Odds Ratio was 0.595. The most dominant variable influences patient satisfaction in the inpatient installation of Massenrempulu District Hospital, Enrekang Regency.

HbE/Beta thalassemia (HbE/β-thalassemia) is one of the common genetic disorders in South East Asia. It is heterogeneous in its clinical presentation and molecular defects. There are genetic modifiers which have been reported to influence the disease severity of this disorder. The aim of this study was to determine the genetic polymorphisms which were responsible for the disease clinical diversity. A case-control study was conducted among Malay transfusion-dependent HbE/β-thalassemia patients. Patients who were confirmed HbE/β-thalassemia were recruited and genotyping study was performed on these subjects. Ninety-eight patients were selected and divided into moderate and severe groups based on clinical parameters using Sripichai scoring system (based on hemoglobin level, spleen size, growth development, the age of first transfusion and age of disease presentation). Forty-three (44.9%) and 55 (56.1%) patients were found to have moderate and severe clinical presentation, respectively. Genotyping analysis was performed using Affymetrix 6.0 microarray platform. The SNPs were filtered using PLINK and Manhattan plot by R software. From the GWAS results, 20 most significant SNPs were selected based on disease severity when compared between moderate and severe groups. The significant SNPs found in this study were mostly related to thalassemia complications such as rs7372408, associated with KCNMB2-AS1 and SNPs associated with disease severity. These findings could be used as genetic predictors in managing patients with HbE/β-thalassemia and served as platform for future study.

This is the first study evaluating the frequencies of nucleophosmin (NPM1) gene mutation according to the hyperleukocytosis (HL) grading score. The current two cut off values of this score in acute myeloid leukaemia (AML) patients are [1] those with 50–100 × 109/L and [2] those with ≥ 100 × 109/L total WBC count. The score represents the current clinically based definition of HL in patients with AML. A total of 90 patients with AML were included. AML patients were stratified into three groups: [1] those with a WBC count below 50 × 109/L (n = 33), [2] those with a WBC count 50–100 × 109/L (n = 29) and [3] those with a WBC above 100 × 109/L (n = 28). Complete blood cell count, immunophenotyping and PCR of the exon 12 of NPM1 gene followed by sequencing analysis were done. NPM1 mutations were detected in 20/90 (22.2%) of patients with AML involving exon 12 of NPM1 gene and showed significant correlations with some hematologic characteristics. Contrary to expectation, no statistically significant difference was found in the WBC counts according to the NPM1 gene the mutation status among the studied groups. Also, there were no significant differences in the WHO classification categories according to the HL grading score. The difference in the frequency of NPM1 mutation in Asian compared to Western patients might be attributed to biology and aetiology variation of the disease in different population. The current two cut off values defining the HL are molecularly unreliable in spite of being clinically defined.

Alterations in the three chemosensory modalities—smell, taste, and chemesthesis—have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June and 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 is more widespread than previously reported among Asians and may be related to the infectivity of viral strains.Study Registration: NMRR-20-934-54803 and NCT04390165.

Latar belakang: Angka Kematian Ibu (AKI) merupakan salah satu indikator pembangunan kesehatan di Indonesia. Upaya percepatan penurunan AKI dapat dilakukan dengan menjamin agar setiap ibu mampu mengakses pelayanan kesehatan ibu hamil yang berkualitas. Apabila antenatal care dimanfaatkan dengan baik maka kesehatan ibu dapat terpantau secara berkesinambungan dari masa kehamilan sampai dengan persalinan. Metode: Desain penelitian adalah kuantitatif dengan rancangan cross sectional study. Populasi pada penelitian ini adalah semua ibu yang memiliki bayi usia 0-11 bulan di Kabupaten Gowa sebanyak 122 orang. Sampel sebanyak 93 orang diambil dengan menggunakan teknik accidental sampling, besar sampel ditentukan dengan menggunakan rumus Slovin Hasil: Persepsi ibu hamil terhadap peran petugas kesehatan dalam pelayanan antenatal berdasarkan pengorbanan moneter tidak menunjukkan korelasi. Ibu hamil yang memiliki persepsi pengorbanan moneter kecil dan mengatakan peran petugas kesehatan kurang dalam pelayanan antenatal sebanyak 90,0%. Ibu hamil yang memiliki persepsi pengorbanan moneter sangat kecil dan mengatakan peran petugas kesehatan kurang sebanyak 83.1%. Sedangkan persepsi pengorbanan waktu menunjukkan adanya korelasi dengan peran petugas kesehatan dalam pelayanan antenatal. Ibu hamil yang memiliki persepsi pengorbanan waktu besar dan mengatakan peran petugas kesehatan kurang dalam pelayanan antenatal sebanyak 100%. Ibu hamil yang memiliki persepsi pengorbanan moneter besar dan mengatakan peran petugas kesehatan kurang dalam pelayanan antenatal sebanyak 90.2%. Kesimpulan: Persepsi ibu hamil terhadap peran petugas kesehatan dalam pelayanan antenatal berdasarkan pengorbanan moneter tidak menunjukkan korelasi sedangkan berdasarkan pengorbanan waktu menunjukkan ada korelasi. Perlu meningkatkan kecepatan proses pelayanan pemeriksaan kehamilan pada ibu hamil oleh tenaga kesehatan. Kata kunci: Pelayanan antenatal, Ibu Hamil, Pengorbanan, Waktu, Moneter Abstract Background: Maternal Mortality Rate (MMR) is one indicator of health development in Indonesia. Efforts to accelerate the reduction of MMR can be done by ensuring that every mother is able to access quality maternal health services. If antenatal care is utilized properly, maternal health can be monitored continuously from pregnancy to delivery. Methods: The study design was quantitative with a cross sectional study design. The population in this study were all pregnant women who had a gestational age of 7 to 9 months in Gowa Regency as many as 122 people. A sample of 93 people was taken using accidental sampling technique, the sample size was determined using the Slovin formula. Results: Perception of pregnant women towards the role of health workers in antenatal care based on monetary sacrifice did not show a correlation. Pregnant women who have a perception of small monetary sacrifice and say the role of health workers is lacking in antenatal care are 90.0%. Pregnant women who have a perception of monetary sacrifice are very small and say the role of health workers is less as much as 83.1%. While the perception of sacrifice of time shows a correlation with the role of health workers in antenatal care. Pregnant women who have the perception of sacrifice of big time and say the role of health workers lacking in antenatal care as much as 100%. Pregnant women who have a perception of great monetary sacrifice and say the role of health workers is lacking in antenatal care are 90.2%. Conclusion: Perception of pregnant women towards the role of health workers in antenatal care based on monetary sacrifice does not show correlation while based on time sacrifice shows there is correlation. Need to increase the speed of the process of pregnancy examination services for pregnant women by health workers. Keywords: Antenatal care, Pregnant Women, Sacrifice, Time, Monetary

Previous study has shown the antimicrobial activities of mucus protein extracted from Anabastestudineus. In this study, we are interested in characterizing the anticancer activity of the A.testudineus antimicrobial peptides (AMPs). The mucus was extracted, fractioned, and subjected to antibacterial activity testing to confirm the fish's AMPs production. The cytotoxic activity of each fraction was also identified. Fraction 2 (F2), which shows toxicity against MCF7 and MDA-MB-231 were sent for peptide sequencing to identify the bioactive peptide. The two peptides were then synthetically produced and subjected to cytotoxic assay to prove their efficacy against cancer cell lines. The IC50 for AtMP1 against MCF7 and MDA-MB-231 were 8.25 ± 0.14 μg/ml and 9.35 ± 0.25 μg/ml respectively, while for AtMP2 it is 5.89 ± 0.14 μg/ml and 6.97 ± 0.24 μg/ml respectively. AtMP1 and AtMP2 treatment for 48 h induced breast cancer cell cycle arrest and apoptosis by upregulating the p53, which lead to upregulate pro-apoptotic BAX gene and downregulate the anti-apoptotic BCL-2 gene, consequently, trigger the activation of the caspase-3. This interaction was supported by docking analysis (QuickDBD, HPEPDOCK, and ZDOCK) and immunoprecipitation. This study provided new prospects in the development of highly effective and selective cancer therapeutics based on antimicrobial peptides.

Introduction Post-operative atrial fibrillation (POAF) is associated with poorer outcomes, increased resource utilisation, morbidity and mortality. Its pathogenesis is initiated by systemic inflammation and oxidative stress. It is hypothesised that a potent antioxidant and anti-inflammatory agent such as tocotrienol, an isomer of Vitamin E, could reduce or prevent POAF. Aims The aim of this study is to determine whether a potent antioxidative and anti-inflammatory agent, Tocovid, a tocotrienol-rich capsule, could reduce the incidence of POAF and affect the mortality and morbidity as well as the duration of ICU, HDU and hospital stay. Methods This study was planned as a prospective, randomised, controlled trial with parallel groups. The control group received placebo containing palm superolein while the treatment group received Tocovid capsules. We investigated the incidence of POAF, the length of hospital stay after surgery and the health-related quality of life. Results Recruitment commenced in January 2019 but the preliminary results were unblinded as the study is still ongoing. Two-hundred and two patients have been recruited out of a target sample size of 250 as of January 2021. About 75% have completed the study and 6.4% were either lost during follow-up or withdrew; 4% of participants died. The mean age group was 61.44 ± 7.30 years with no statistical difference between the groups, with males having a preponderance for AF. The incidence of POAF was 24.36% and the mean time for developing POAF was 55.38 ± 29.9 h post-CABG. Obesity was not a predictive factor. No statistically significant difference was observed when comparing left atrial size, NYHA class, ejection fraction and the premorbid history. The mean cross-clamp time was 71 ± 34 min and the mean bypass time was 95 ± 46 min, with no difference between groups. There was a threefold increase in death among patients with POAF (p = 0.008) and an increase in the duration of ICU stay (p = 0.01), the total duration of hospital stay (p = 0.04) and reintubation (p = 0.045). Conclusion A relatively low incidence rate of POAF was noted although the study is still ongoing. It remains to be seen if our prophylactic intervention using Tocovid would effectively reduce the incidence of POAF. Clinical Registration Number: US National Library of Medicine. Clinical Trials - NCT03807037. Registered on 16th January 2019. Link: https://clinicaltrials.gov/ct2/show/NCT03807037

This study explored the impact of online lectures that were developed using principles of cognitive load theory (CLT) and cognitive theory of multimedia learning (CTML) on health profession students' lecture comprehension, cognitive load, cognitive engagement, and intrinsic motivation in learning. A total of 215 first-year undergraduate students in medical, dentistry, and nutrition programs participated in this pre-post quasi experimental study. The students attended a typical face-to-face lecture on Day-1 of the intervention, followed by a CLT-based online lecture 8 weeks thereafter. Their comprehension of the lecture topics was measured through pre- and post-lecture assessments, and their cognitive load, cognitive engagement, and motivation were measured immediately after each lecture session. The analysis revealed that the CLT-based online lectures promoted the students' comprehension of the lecture content (p < 0.001), self-perceived learning (p < 0.001), engagement toward the learning material, and motivation to learn (p = 0.025). It was also effective at reducing the students' intrinsic and extraneous cognitive loads (p < 0.001). Hence, designing online lectures using CLT and CTML principles could be an effective method to promote students' knowledge and comprehension, cognitive engagement, and learning motivation. However, further research is needed to investigate the applicability and impact of CLT-based online lectures in non-health profession disciplines.