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INTRODUCTION AND IMPORTANCE: Bleeding during pregnancy or during childbirth can cause significant morbidity and mortality for the mother and baby, this can be overcome by performing a caesarean section (C-section) and blood transfusions. Although blood transfusions can save lives, there is a risk such as transfusion reactions, transmission of infection, and anaphylaxis. Giving autologous blood transfusion can reduce the risk of these events. This case report aims to investigate the advantages of autologous blood transfusion in managing the patient's hemodynamic status compared to homologous blood transfusion. CASE PRESENTATION: A 21-year-old female (G2P1A0) with antepartum hemorrhage (APH) due to placenta previa underwent emergency C-section with intrauterine device installation and hysterectomy. The patient received an autologous transfusion to improving the hematocrits and hemoglobin within 30 min. Autologous transfusion provided routine postoperative hemodynamics, electrolytes, and blood stability. However, it could not completely replace homologous transfusion. CLINICAL DISCUSSION: Autologous transfusion reduces transfusion response, infection risk, and immunosuppression. Consequently, it reduces the need for allogenic blood supplies and enables safer transfusion for people with rare blood types and various auto-antibodies. CONCLUSION: Autologous transfusions may provide better outcomes in C-section surgery for APH patients due to placenta previa. Thus, we recommend the use of autologous over homologous transfusion. Further research is required to compare them to a large population.

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BACKGROUND: This trial is a parallel, two-arm, non-blinded cluster randomised controlled trial that is under way in Singapore, with the aim of measuring the efficacy of male Wolbachia-infected Aedes aegypti deployments in reducing dengue incidence in an endemic setting with all four dengue serotypes in circulation. The trial commenced in July 2022 and is expected to conclude in September 2024. The original study protocol was published in December 2022. Here, we describe amendments that have been made to the study protocol since commencement of the trial. METHODS: The key protocol amendments are (1) addition of an explicit definition of Wolbachia exposure for residents residing in intervention sites based on the duration of Wolbachia exposure at point of testing, (2) incorporation of a high-dimensional set of anthropogenic and environmental characteristics in the analysis plan to adjust for baseline risk factors of dengue transmission, and (3) addition of alternative statistical analyses for endpoints to control for post hoc imbalance in cluster-based environmental and anthropogenic characteristics. DISCUSSION: The findings from this study will provide the first experimental evidence for the efficacy of releasing male-Wolbachia infected mosquitoes to reduce dengue incidence in a cluster-randomised controlled trial. The trial will conclude in 2024 and results will be reported shortly thereafter. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT05505682. Registered on 16 August 2022. Retrospectively registered. Last updated 11 November 2023.

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INTRODUCTION AND IMPORTANCE: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a less invasive procedure to diagnose and treat biliary disease. However, it has a mortality rate of 0.43-1 %. ERCP has several complication that can arise, one of which is a subcapsular hepatic hematoma (SCH). Incidence of subcapsular hematoma is about 1 %. CASE PRESENTATION: In this case we reported a 33-years-old female complained of jaundice in the entire and right upper abdominal pain. She underwent ERCP and stent placement due to an obstruction in the biliary system. The day after ERCP, she has complained about persistent sharp pain on the upper abdomen. Abdominal ultrasound showed SCH. She then underwent laparoscopic diagnostic and showed the hematoma at the subcapsular of the right upper lobe. CLINICAL DISCUSSION: Then it was decided to conservative therapy with an antibiotic and analgesics. Cholecystectomy was also performed to treat cholelithiasis. Patient discharge from hospital in three days after surgery with a good condition and no symptom about stomachache. CONCLUSION: Conservative treatment is the goal while managing SCH in a good hemodynamic state. Once a hematoma has been identified, treatment with a broad-spectrum antibiotic should be started since the hematoma may turn into a secondary infection that requires invasive techniques and drainage.

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INTRODUCTION AND IMPORTANCE: Diplopia and ptosis are the most common symptoms of oculomotor nerve palsy, which may be caused by increased intracranial pressure causing cranial nerve palsies. If no significant improvement is noted following surgical correction or pharmacological therapies for the underlying cause, acupuncture treatment can be considered as adjuvant therapy to achieve complete functional resolution of the oculomotor nerve. CASE PRESENTATION: A 27-year-old male patient presented with ptosis and diplopia due to a postoperative craniotomy subdural hematoma (SDH). The patient received several sessions of acupuncture treatments which lasted a total of 45 days. The patient received manual acupuncture points of GB 20 and electrostimulator acupuncture points of ST 2, BL 2, GB 14, TE 23, EX HN 5, LI 4, bilaterally, and noticed improvement in the minor neurological deficits in diplopia and ptosis after 45 days. CLINICAL DISCUSSION: Several filiform needle insertions with stimulation in designated nerve distribution areas cause neural stimulation. This is believed to cause local biochemical and neural stimulation, followed by the release of mediators. CONCLUSION: Acupuncture can improve the neurological deficits associated with conditions such as ptosis and diplopia following SDH surgery.

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INTRODUCTION AND IMPORTANCE: Cystic hygroma in adult is a rare condition that is typically treated with surgery, but in some cases, the cyst may be difficult to completely remove, leading to the potential of recurrence. CASE PRESENTATION: In this case report, we describe the use of ethanol ablation as an alternative treatment for a rapidly growing cystic hygroma in an adult patient. The patient had a lump on her neck for 2 years that had been slowly growing. The cyst was drained and filled with ethanol, and a drain was left in place for 24 h. Follow-up evaluations showed no evidence of the lump, no pain, and no discharge after 6 months. CLINICAL DISCUSSION: Cystic hygroma typically affects young children, but it can also occur in adults. It presents as a painless, progressive mass that is soft, fluctuant, and not tender. It is often located in the neck, axilla, or mediastinum, and can also rarely occur in the groin or retroperitoneal spaces. Surgical excision is the primary treatment, but alternatives such as laser surgery, cryotherapy, electrocautery, steroid administration, sclerotherapy, embolization, and radiation therapy have also been used. In this case report, ethanol ablation was used as a sclerosing agent and was successful in treating the patient's cystic hygroma. CONCLUSION: Ethanol ablation with instillation may be an effective and efficient treatment option for adult single lobe cysts of hygroma colli, but further research is needed to confirm this.

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Objectives: A high prevalence of tobacco smoking contributes to a high incidence of acute ischemic stroke (AIS) in Indonesia. Large-artery atherosclerosis is known to be a significant cause of AIS. The present study was aimed at evaluating the association between AIS and atherosclerosis on the basis of carotid intima-media thickness (CIMT) measurements in a tertiary care hospital in Indonesia. Methods: A total of 79 patients with AIS (case study group) and 79 individuals without AIS (control group) were included. Chi-squared tests and odds ratios were used to compare the groups and determine associations. We also considered factors such as age, body mass index (BMI), sex, type-2 diabetes mellitus (T2DM), hypertension, smoking status, dyslipidemia, socioeconomic status, and educational level in the statistical analyses. A p-value <0.05 was considered statistically significant. Results: Stratification of atherosclerosis into case study and control groups with respect to all study variables indicated a significant relationship (p > 0.05) between atherosclerosis and all variables except low socioeconomic status (p = 0.265) and low educational level (p = 0.180). Regression analysis demonstrated that a BMI ≥25 kg/m2, compared with a normal BMI, was associated with a 2.139-fold higher risk of atherosclerosis. Conclusions: AIS was associated with atherosclerosis, on the basis of CIMT measurements, according to age, BMI, sex, T2DM, hypertension, smoking status, dyslipidemia, socioeconomic status, and education level in the Indonesian population.

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@#Introduction: Cytomegalovirus (CMV) infection in pregnancy is the commonest cause of congenital infection worldwide. Primary CMV infection in pregnancy carries a higher risk of fetal transmission compared to non-primary infection. This study aims to determine the cytokines expression in pregnant women with primary and non-primary CMV infections in both types of infection. Methods: This prospective cohort study was conducted at Microbiology Laboratory, Universiti Sains Malaysia (USM) from January 2019 until June 2020. Seventy-four pregnant women with abnormal pregnancy outcomes with positive CMV IgG with or without IgM by electrochemiluminescence assay (ECLIA) were subjected to IgG avidity assay by ECLIA method to discriminate primary and non-primary CMV infection. Later, the sera were subjected to magnetic Luminex multiplex enzyme-linked immunosorbent assay for cytokine analysis to determine their concentrations in both primary and non-primary CMV infection. Cytokines and chemokines tested were IL-12, IL-2, IFN- γ, TNF-α, IL-1β, IL-6, IL-10, IFN- γ, TNF-α, MCP-1 (CCL-2), and IP-10 (CXCL-10). Results: Concentrations of IL-1β, IL-6, and MCP-1 (CCL-2) were significantly elevated in pregnant women with primary CMV infection with the p-values of (0.001, 0.035, and 0.002) respectively. The intensity of IFN-γ, IL-12, and IL-2 were higher in primary CMV infection with the p-values of (0.018, 0.004, and 0.007). Conclusion: The pro-inflammatory cytokines were expressed significantly in pregnant women with primary CMV infection together with MCP-1 (CCL2), showing predominant Th1 response. The low level of cytokines in non-primary CMV infection might be due to the latent state of CMV in a host.

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The ageing process has been associated with various geriatric issues including frailty. Without early prevention, frailty may cause multiple adverse outcomes. However, it potentially may be reversed with appropriate interventions. The aim of the study is to assess the effectiveness of nutritional education and exercise intervention to prevent frailty among the elderly. A 3-month, single-blind, two-armed, cluster randomized controlled trial of the frailty intervention program among Malaysian pre-frail elderly will be conducted. A minimum of total 60 eligible respondents from 8 clusters (flats) of Program Perumahan Rakyat (PPR) flats will be recruited and randomized to the intervention and control arm. The intervention group will receive a nutritional education and a low to moderate multi-component exercise program. To date, this is the first intervention study that specifically targets both the degree of frailty and an improvement in the outcomes of frailty using both nutritional education and exercise interventions among Malaysian pre-frail elderly. If the study is shown to be effective, there are major potential benefits to older population in terms of preventing transition to frailty. The findings from this trial will potentially provide valuable evidence and serve as a model for similar future interventions designed for elderly Malaysians in the community.

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@#Introduction: The ability to perform daily living activities among the elderly is important, as physical disability may lead to dependency and various public health implications. This study aimed to determine the prevalence of instrumental activities of daily living (IADL) disability and its association with socio-demographic characteristics, dietary intake, social participation, perceived-health-status and risk of falls. Methods: This cross-sectional study was conducted among communitybased elderly in the Gombak District of Selangor. 258 respondents aged 60-88 years old (mean age 66±6.5 years) were recruited through multi-stage proportional sampling. Most of the respondents (88.4%) aged 60-74 years and 11.6% were ≥75 years. IADL disability was determined using an eight-item IADL scale. The presence of IADL disability was defined as needing help in at least one or more of eight-IADL activities. Dietary intake and fall risk were assessed using diet history questionnaire (DHQ) and 21-item fall risk index (FRI-21), respectively. Results: The prevalence of IADL disability among the respondents was 58.1%. A binary logistic regression analyses showed that the following factors predicted IADL disability: advanced age (≥75 years, OR=6.4; 95% CI: 1.3, 30.8), being unmarried (OR=2.5; 95% CI: 1.1, 5.9), unemployed/retired (OR=2.3; 95% CI: 1.2, 4.3), and at risk of falls (OR=2.5; 95% CI: 1.3, 6.1). Conclusion: Predictors such as marriage and employment highlight the importance of social support among elderly. In practical terms, this means that it is incumbent upon caregivers, family members, and the community to provide both physical and emotional support if the functional status of the elderly is to be improved.

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The structural characteristics of the seed-mediated synthesis of heterostructured CuS-ZnS nanocrystals (NCs) and Cu-doped ZnS (ZnS:Cu) NCs synthesized by two different protocols are compared and analyzed. At high Cu dopant concentrations, segregated subclusters of ZnS and CuS are observed. The photoluminescence quantum yield of ZnS:Cu NCs is about 50-80 %; a value much higher than that of ZnS NCs (6 %). Finally, these NCs are coated with a thin silica shell by using (3-mercaptopropyl)triethoxysilane in a reverse microemulsion to make them water soluble. Cytotoxicity experiments show that these silica-coated NCs have greatly reduced toxicity on both cancerous HeLa and noncancerous Chinese hamster ovary cells. The labeling of cancerous HeLa cells is also demonstrated.

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In Malaysia, data on components suitability the established smoking cessation module is limited. This exploratory study aimed to evaluate the suitability of the components developed in the module for group behavioural therapy in workplace smoking cessation programs. Twenty staff were identified but only eight individuals were selected according to the study criteria during the recruitment period in May 2014. Focus group discussion was conducted to identify themes relevant to the behavioural issues among smokers. Thematic analysis yielded seven major themes which were reasons for regular smoking, reasons for quitting, comprehending smoking characteristics, quit attempt experiences, support and encouragement, learning new skills and behaviour, and preparing for lapse/relapse or difficult situations. As a result, the developed module was found to be relevant and suitable for use based on these themes.

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