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Introduction: Different test will have different value of sensitivity, because of that we need to examine whether that test will have association or not. Accurate diagnosis usually contributes by the high sensitivity and high specificity of the test tools. For example, the sensitivity of VEMP was higher than CP possibly because both tests measure the status of different vestibular organs (in this case, the saccule of PVD subjects seems to be more affected than the horizontal SCC). To check for this possibility, McNemar categorical analysis was performed to determine whether the two tests had an association or not. In this situation, p values of less than 0.05 demonstrated that there was no association between the tests. Objectives: To determine the association among MVVSS, VEMP, CP and DHT in peripheral vestibular disordered subjects. Design: This is prospective study. Material and Methods: Forty normal and 65 PVD subjects who fulfilled the inclusion criteria were recruited. All of them required to fill the MVSS and underwent VEMP, CP and DHT. Results: VEMP and CP were found to have no association in both sides. In contrast, a significant association was found between VEMP and CP test with MVVSS in both sides. Contrary, there was no association between the Dix-Hallpike test and MVVSS. Conclusion: Further study with larger sample size will have a better outcome and finding that will benefit the clinician and researchers. [ABSTRACT FROM AUTHOR]

Introduction: Clinical vestibular is one of new fields in Malaysia and there are still lack of data on the detailed pathology distribution among peripheral vestibular disorder (PVD). Detailed information on the pathology distribution is able to assist clinicians and greater understanding on this disorder. Objectives: This study is to determine the Pathology distribution for Peripheral Vestibular Disordered patients in Universiti Sains Malaysia. Design: This is prospective study. Material and Methods: 65 PVD subjects who fulfilled the inclusion criteria were recruited from 2009 till 2010. All of them were required to answer several questions and some data were taken from patient folders. Results: Majority of the PVD cases were from the 4th decade, female and Malay. The highest number of diagnosis is BPPV (29.2%) and the lowest diagnosis is vestibular labyrinthitis (4.6%). The number of subjects with PVD of unknown origin is the second highest (26.2%). Conclusion: Extensive research with bigger sample size is able to improve the research findings that are able to benefit the clinicians. [ABSTRACT FROM AUTHOR]

Background: Imbalance or poor postural control is one of the common clinical presentations in cerebrovascular accident patients. Another consequence is fall where study showed 50-70% post CVA cases experienced fall after attack. Case Report: This is a case of 60 year- old female, housewife, history of CVA 4 years ago (2013), hypertension and hyperlipidemia. Patient had a history of left cerebrovascular accident on 2013 with right weakness and facial weaness. Her main difficulty was when walking and poor balance control. Balance assessment was done before and after the intervention. All clinical balance assessments were normal, but positive findings were found in Fukuda test, Bal Ex Foam test and positive left cerebellar sign. No significant history of hearing loss, tinnitus, and fullness of the ear, high fever, infections and head trauma reported. In Bal Ex Foam test, the result for condition 1 to 3 and 5 was normal, but for condition 4 to condition 6, patient sway to the left (Figure 1). The patient then underwent Bal Ex home based balance exercise therapy at home. After 10 months of therapy, the patient's conditions were reassessed. In general, she showed great improvement in most tests. She reported subjectively that almost 70% of her balance difficulties had improved. She also noted that her postural improved and she able to performed routine daily activities better than before. Bal ex foam test showed normal result in all condition 1-6, the patient was normal completely. Referred to this study it showed chronic CVA case can be managed with home-based balance exercise without medication to improve their postural control. [ABSTRACT FROM AUTHOR]

Introduction: Tinnitus (ringing noise in the ear) is common and not considered as a disorder but it is a disquieting problem experienced by the affected individuals. If not treated, tinnitus sufferers may exhibit serious emotional and psychological disturbances. One of the challenges in the treatment of tinnitus is determining effective therapy for individual sufferers. Of the treatment options, Quranic therapy has the least clinical evidence. Objective: To rectify this, this paper presents the outcomes of psychological evaluations on twelve patients who suffer from tinnitus in a pre and post treatment study with a six months therapy period. Design: They were divided into two different groups according to their mode of treatment (Quranic rhythm and Broadband noise). Both groups of patients on average have been suffering from tinnitus for 7.3 years. Material & Methods; Upon informed consent, all patients completed the Malay versions of Tinnitus Evaluation Questionnaire (BEST), Beck Anxiety Inventory (BAI-M), Beck Depression Inventory (BDI-M) and Automatic Thought Questionnaire (ATQ-M). Result: The results showed that Group 1 (Quranic rhythm) evidenced more functional and psychological improvement than Group 2 (Broadband noise). Post therapy, group 1 showed a lower mean score in BDI-M (57% improvement, i.e. less depression) compared to group 2. In addition, results for BAI-M and ATQ-M post therapy showed some differences between the two groups (BAI: group 1 = 13% & group 2 = 10.52%) (ATQ: group 1 = 18.42% & group 2 = 19.09%). The mean differences between the two groups are 22% for BDI, 0.67% for ATQ and 2.48% for BAI. Discussion; This case study provides some evidence that tinnitus patients benefitted from Quranic rhythm therapy compared to broadband noise therapy. In particular, the feeling of depression may get worse if the duration of untreated tinnitus is longer. Conclusion: To improve validity, more studies with a bigger sample size that would enable comparisons across tinnitus onset ages and other types of tinnitus treatments are recommended for a wider generalization. [ABSTRACT FROM AUTHOR]

Introduction: The Bal Ex Mobile Virtual Room new alternative treatment than can benefits of reducing logistic costs and hospital-based rehabilitation costs for balance disorder patients i.e visual vertigo. Visual vertigo is one of the common symptoms among vestibular disordered patients that is crucially in term management. Previous finding showed visual stimulation exercise is one of an optimum mode of treatment for visual vertigo patients. Based on the success of the original Malay language version, the module has been translated to Arabic in order to offer the same benefits to Arabic rural communities and those who are unable to afford the high cost of hospital-based rehabilitation. Objectives: To develop the Arabic language version of Bal Ex Mobile Virtual Room: Home-based training module for visual vertigo rehabilitation. Design: Forward translation methods were used for this translation. Material and Methods: The English version was translated into the Arabic language by a lecturer that is an expert-level user in both English and Arabic languages. The methodology involved four stages. Results: The Arabic version of Bal Ex Mobile Virtual Room was developed. This home-based module enables visual vertigo and vestibular disorder patients and survivors to continue their vestibular rehabilitation at home with minimal hospital follow- ups. This module is especially beneficial to those who are from rural areas or live far from hospitals. Conclusion: As a conclusion, we hope that this new invention will provide alternative and a better rehabilitative option for visual vertigo patients and their family members especially among the Arabic community. Further clinical validation study should be carried out in order to produce a better module that is adapted accordingly to the Arabic culture. [ABSTRACT FROM AUTHOR]

Introduction: The Bal Ex Stand up is a new alternative treatment that can benefit by reducing logistic costs and hospital- based rehabilitation costs for balance disorder patients i.e vestibular disordered, mal debarquement syndrome or post stroke. The main equipment used in this module is the car tube which is used as a base of support during therapy. Previous finding showed balance exercise is one of optimum modes of treatment for balance disordered patients. Based on the success of the original Malay language version, the module has been translated to Arabic in order to offer the same benefits to Arabic rural communities and those who are unable to afford the high cost of hospital-based rehabilitation. Objectives: To develop the Arabic language version of Bal Ex Stand up Manual footplate for balance rehabilitation module for vestibular rehabilitation. Design: Forward translation methods were used for this translation. Material and Methods: The English version was translated into the Arabic language by a lecturer that is an expert-level user in both English and Arabic languages. The methodology involved four stages. Results: The Arabic version of Bal Ex Stand up was developed. This latest and new invention which is one of alternative home-based module enables vestibular disorder and balance disordered patients and survivors to continue their vestibular rehabilitation at home with minimal hospital follow-ups. This module is especially beneficial to those who are having chronic balance problem. Conclusion: As a conclusion, we hope that this new invention will provide alternative and a better rehabilitative option for balance disordered patients (vestibular disordered or post stroke) and their family members especially among the Arabic community. Further clinical validation study should be carried out in order to produce a better module that is adapted accordingly to the Arabic culture. [ABSTRACT FROM AUTHOR]

Asia remains vulnerable to new and emerging infectious diseases. Understanding how to improve next generation sequencing (NGS) use in pathogen surveillance is an urgent priority for regional health security. Here we developed a pathogen genomic surveillance assessment framework to assess capacity in low-resource settings in South and Southeast Asia. Data collected between June 2022 and March 2023 from 42 institutions in 13 countries showed pathogen genomics capacity exists, but use is limited and under-resourced. All countries had NGS capacity and seven countries had strategic plans integrating pathogen genomics into wider surveillance efforts. Several pathogens were prioritized for human surveillance, but NGS application to environmental and human-animal interface surveillance was limited. Barriers to NGS implementation include reliance on external funding, supply chain challenges, trained personnel shortages and limited quality assurance mechanisms. Coordinated efforts are required to support national planning, address capacity gaps, enhance quality assurance and facilitate data sharing for decision making., (© 2024. The Author(s).)

Introduction: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder where there is persistent dizziness or unsteadiness occurring on most days for more than 3 months duration. Treatment recommendations for PPPD include vestibular rehabilitation therapy (VRT) with or without medications and/or cognitive behavioral therapy., Objectives: This paper is a pilot study designed to compare the effects of Bal Ex as a home-based VRT on the quality of life (EQ-5D), dizziness handicap (DHI) and mental health (DASS-21) against hospital-based VRT., Design: This was an assessor-blinded, randomized controlled pilot study where PPPD patients were randomly selected to undergo Bal Ex, the home-based VRT (intervention group) or hospital-based (control group) VRT. The participants were reviewed at 4 weeks and 12 weeks after the start of therapy to assess the primary endpoints using the subjective improvement in symptoms as reported by patients, changes in DHI scores, DASS-21 scores and EQ5D VAS scores., Results: Thirty PPPD patients successfully completed the study with 15 in each study group. Within 4 weeks, there were significant improvements in the total DHI scores as well as anxiety levels. By the end of 12 weeks, there were significant improvements in the DHI, DASS-21 and EQ5D. The degree of improvement between Bal Ex and the control was comparable., Conclusion: VRT is an effective modality in significantly improving quality of life, dizziness handicap, depression, and anxiety levels within 3 months in PPPD. Preliminary results show Bal Ex is as effective as hospital-based VRT and should be considered as a treatment option for PPPD.

Background: The graviceptive otolith function can be measured using subjective visual horizontal (SVH) testing. Nevertheless, more research efforts are required to understand the essential variables affecting SVH., Objective: The aim of the present study was to determine the effects of type of visual image and gender on subjective visual horizontal (SVH) perception among healthy adults., Materials and Methods: In this comparative study, 50 healthy young adults were enrolled. While in an upright body position, they were required to report their perception of horizontality for two types of visual images (solid line and arrow pattern) using a computerized SVH device., Results: The arrow pattern produced significantly bigger SVH angles than the solid line ( p < .001). In contrast, no significant influence of gender was found on SVH results ( p  = .743), Based on the statistical outcomes, the preliminary normative data for SVH were established., Conclusions and Significance: The arrow pattern (a more complex visual image) produced bigger SVH deviations than the simple solid line image. In contrast, the horizontality perception does not appear to be affected by gender. The preliminary normative SVH data gathered from the present study can be beneficial for clinical and future research applications.

The present study aimed to determine the test-retest reliability of subjective visual horizontal (SVH) testing when tested with solid and dotted line images. In this repeated measures study, 36 healthy young Malaysian adults (mean age=23.3±2.3 years, 17 males and 19 females) were enrolled. All of them were healthy and had no hearing, vestibular, balance, or vision problems. The SVH angles were recorded from each participant in an upright body position using a computerized device. They were asked to report their horizontality perception for solid and dotted line images (in the presence of a static black background). After 1 week, the SVH procedure was repeated. The test-retest reliability of SVH was found to be good for both solid line [intraclass correlation (ICC)=0.80] and dotted line (ICC=0.78). As revealed by Bland-Altman plots, for each visual image, the agreements of SVH between the two sessions were within the clinically accepted criteria (±2°). The SVH testing was found to be temporally reliable, which can be clinically beneficial. Both solid and dotted lines in the SVH testing are reliable to be used among young adults.

The blood-brain barrier (BBB) is a physical barrier that restricts the passage of cells and molecules as well as pathogens into the central nervous system (CNS). Some viruses enter the CNS by disrupting the BBB, while others can reach the CNS without altering the integrity of the BBB. Even though dengue virus (DENV) is not a distinctive neurotropic virus, the virus is considered to be one of the leading causes of neurological manifestations. In this study, we found that DENV is able to compromise the integrity of a murine in vitro blood-brain barrier (BBB) model, resulting in hyperpermeability, as shown by a significant increase in sucrose and albumin permeability. Infection of brain endothelial cells (ECs) was facilitated by the presence of glycans, in particular, mannose and N-acetyl glucosamine residues, on cell surfaces and viral envelope proteins, and the requirement for glycan moieties for cell infection was serotype-specific. Direct viral disruption of brain ECs was observed, leading to a significant decrease in tight-junction protein expression and peripheral localization, which contributed to the changes in BBB permeability. In conclusion, the hyperpermeability and breaching mechanism of BBB by DENV are primarily due to direct consequences of viral infection of ECs, as shown in this in vitro study.

Objectives: Subjective visual vertical (SVV) is a simple, quick and reliable test for measuring utricular function. The literature on the effects of fundamental demographic variables such as age and gender on SVV is inconclusive and should be supported by research with larger samples. The aim of the present study was to determine the influences of age, gender and geometric pattern of visual image on SVV among healthy adults., Study Design: This study employed a repeated measures design., Settings: Otorhinolaryngology Clinic, Hospital Universiti Sains Malaysia, Malaysia., Participants: Eligible Malaysian adults (N = 187, aged 21-75 years) were recruited and categorised into young (N = 60), middle-aged (N = 66) and older (N = 61) groups. Most of them were Malay, and 51.3% were men., Main Outcome Measures: Subjective visual vertical angles (in degrees) were determined from each participant in a static upright condition using a computerised SVV device. They were asked to indicate their verticality perception for three types of visual images (solid line, dotted line and arrow pattern)., Results: Three-way mixed ANOVA revealed insignificant influences of age and gender on SVV results (P > 0.05). In contrast, mean SVV angles were significantly higher for the arrow pattern than for other visual images (P = 0.004)., Conclusion: While the insignificant influences of age and gender on static SVV are further ascertained with larger samples, the perception of verticality is less accurate when aligning a more geometrically complex visual image (ie, arrow pattern). Further SVV research on vestibular-disordered patients is beneficial, particularly to verify the normative data obtained with this complex visual image., (© 2018 John Wiley & Sons Ltd.)

The complete genome sequence of a human enterovirus 71 strain isolated in Brunei in 2006 was determined. Phylogenetic analysis based on the complete genome sequence classified this strain into subgenogroup B5.

Background: Chronic vestibular dysfunction is a frustrating problem in the elderly and can have a tremendous impact on their life, but only a few studies are available. Vestibular rehabilitation therapy (VRT) is an important therapeutic option for the neuro-otologist in treating patients with significant balance deficits., Objectives: The purpose of this study was to assess the effect of vestibular rehabilitation on dizziness in elderly patients with chronic vestibular dysfunction., Materials and Methods: A total of 33 patients older than 60 years with chronic vestibular dysfunction were studied. Clinical and objective vestibular tests including videonystagmography (VNG) and dizziness handicap inventory (DHI) were carried out at their first visit, 2 weeks, and 8 weeks post-VRT. The VRT exercises were performed according to Cawthorne and Cooksey protocols., Results: Oculomotor assessments were within normal limits in all patients. Nineteen patients (57.57%) showed abnormal canal paralysis on caloric testing which at follow-up sessions; CP values were decreased remarkably after VRT exercises. We found a significant improvement between pre-VRT and post-VRT total DHI scores (P < 0.001). This improvement was most prominent in functional subscore., Conclusions: Our study demonstrated that VRT is an effective therapeutic method for elderly patients with chronic vestibular dysfunction.

We modified the capsid protein of a human enterovirus 71 (HEV71) belonging to subgenogroup C4 (HEV71-C4) to generate a mouse virulent strain, based on the genetic information derived from our previous subgenogroup B3 mouse-adapted virus. Infectious clone-derived mutant virus populations containing the capsid protein mutations VP1-Q145E and VP1-Q145G were generated by site-directed mutagenesis of an infectious clone of a subgenogroup C4 strain. Viruses expressing the VP1-Q145E were virulent in 5-day-old BALB/c mice with 100 % mortality rate observed. Skeletal muscle appears to be the primary site of replication of this virus with limb muscle showing severe myositis. Virus was also isolated from spleen, liver, heart and brain of infected mice. This study demonstrates that introducing a key mutation into the HEV71 VP1 capsid protein is able to generate a mouse virulent HEV71 strain from a different genogroup as well as providing an alternative strategy for the generation of mouse virulent HEV71.

Introduction: The Vertigo symptom scale (VSS) is a well established tool for the evaluation of vestibular disorders and the associated symptoms of autonomic arousal and somatosensation. By using a validated Malay version of vertigo symptom scale (MVVSS) questionnaire, the severity of the vertigo from patients' perspective can be determined and rated. Before MVVSS can be applied clinically among Malaysians, it was of interest to determine its clinical value in identifying vestibular disorders., Method: Forty normal and 65 PVD subjects participated in this cross-sectional study. Normal subjects were recruited amongst Universiti Sains Malaysia (USM) staff and students who had no history of ear and vestibular disorders., Results: Mean total score of MVVSS in normal and PVD subjects were 13.9 +/- 11.1 and 30.1 +/- 20.9, respectively. When the total scores of normal and PVD group were compared, the Mann-Whitney U test showed that there was a significant difference between the two groups (p < 0.05). This is consistent with previous studies. It was also of interest to see if subtypes of PVD [benign paroxymal positional vertigo (BPPV), Meniere's disease, labyrinthitis and unknown] have different MVVSS results. However, analysis of variance (ANOVA) found no significant difference in term of outcomes of MVVSS among the different PVD pathologies. Using receiver operating characteristic curve (ROC) method, the sensitivity and specificity of MVVSS were 71% and 60%, respectively., Conclusion: MVVSS is able to discriminate clinically among the normal and PVD subjects. However, it is not a good indicator for differential diagnosis of PVD subtypes, at least in this study. Its sensitivity and specificity in clinical diagnosis are reasonably high. Perhaps a bigger sample size would be useful to further study the clinical usefulness of MVVSS.

Most human enterovirus 71 (HEV71) strains infect only primates and are unable to cause clinically apparent infection in mice. Here we describe a mouse-adapted HEV71 strain that belongs to sub-genogroup B5 with increased virulence in newborn BALB/c mice. The mouse-virulent strain was initially selected by serial passage of a HEV71 clinical isolate (HEV71-B5) in Chinese hamster ovary (CHO) cells (CHO-B5), followed by serial passage in newborn mice. Virus from the fifth mouse passage was cultured twice on Vero cells and designated as MP-B5. MP-B5 induces severe disease of high mortality in newborn mice in a dose-dependent manner. Skeletal muscle is the primary site of virus replication and results in severe myositis. CHO-B5 harbours a single amino acid substitution (K(149) → I) in the VP2 capsid protein. Five additional nucleotide sequence changes were identified in MP-B5, two of which are located in the 5' UTR and the three within the open reading frame (ORF). Two of the ORF mutations resulted in deduced amino acid changes in the capsid protein VP1: S(241) → L and K(244) → E; the third ORF mutation was a synonymous C → T change at nucleotide position 6072 within the 3D polymerase gene. Infectious cDNA clone-derived mutant virus populations of HEV71 belonging to sub-genogroup B3 (CHO-26 M) that contain the VP1 mutations identified in MP-B5 were generated in order to determine the mutation(s) responsible for mouse virulence. Only viruses expressing the VP1 (K(244) → E) mutation were virulent in 5-day-old BALB/c mice, indicating that the VP1 (K(244) → E) change is the critical genetic determinant of mouse adaptation and virulence in this model., (Copyright © 2012 Elsevier B.V. All rights reserved.)

We selected Chinese hamster ovary (CHO) cell-adapted strains of human enterovirus 71 (HEV71) belonging to sub-genogroups B5 (HEV71-B5) and C2 (HEV71-C2) by serial passage in CHO cells at a high multiplicity of infection. During the course of CHO cell passage, virus growth improved significantly, with increasing virus titres and the presence of cytopathic effect observed. A study of virus growth kinetics revealed that the CHO cell-adapted strains of HEV71-B5 (CHO-B5) and HEV71-C2 (CHO-C2) grew efficiently in CHO cells with maximum titres >100-fold higher than unadapted parental virus. Both CHO-B5 and CHO-C2 harboured single amino acid mutations within the VP2 capsid protein gene. CHO-B5 has an amino acid substitution of K(149)→I in VP2 and CHO-C2 has an amino acid substitution of K(149)→M in VP2. An isolate of sub-genogroup C4 (HEV71-C4) failed to adapt to CHO cells during serial passage. Infectious cDNA clone-derived populations of HEV71-C4 containing the mutations K(149)→I or K(149)→M in VP2 were generated by site-directed mutagenesis. Both mutations resulted in the ability of the virus to replicate efficiently in CHO cells, indicating that amino acid position 149 in VP2 is critical for the adaptation of HEV71 to growth in CHO cells., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Cyprinid herpesvirus-3 (CyHV-3), or koi herpesvirus (KHV), is responsible for high mortalities in aquaculture of both common carp (Cyprinus carpio carpio) and koi carp (Cyprinus carpio koi) worldwide. The complete genomes of three CyHV-3 isolates showed more than 99% of DNA sequence identity, with the majority of differences located in short tandem repeats, also called VNTR (variable number of tandem repeats). By targeting these variations, eight loci were selected for genotyping CyHV-3 by multiple locus VNTR analysis (MLVA). CyHV-3 strains obtained after sequential in vivo infections exhibited identical MLVA profiles, whereas samples originating from a single isolate passaged 6 and 82 times in vitro exhibited mutations in two of the eight loci, suggesting a relatively slow genetic evolution rate of the VNTRs. The method was subsequently applied on 38 samples collected in Indonesia, France and the Netherlands. Globally, the isolates grouped in two main genetic clusters, each one divided in two subgroups including either CyHV-3-U/I or CyHV3-J. Interestingly, Indonesian strains were rather distant from CyHV-3-J isolate. The results of the present study indicate that these VNTR molecular markers are efficient in estimating the genetic diversity among CyHV-3 isolates and are therefore suitable for further molecular epidemiological studies., (Copyright © 2011 Elsevier B.V. All rights reserved.)