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BACKGROUND: Respiratory distress and failure is a complication of the coronavirus disease (COVID-19) and tracheostomy may be necessary in cases of prolonged intubation in order to reduce mechanical ventilation duration. However, according to the Canadian Society of Otolaryngology-Head and Neck Surgery guidelines, which our institution applies, patients should not undergo tracheostomy unless cleared of the virus to reduce its spread among healthcare workers because tracheostomy is an aerosolized procedure. This study aimed to identify the outcomes of prolonged intubation in patients with and without COVID-19 who underwent tracheostomy and to determine the morbidity and mortality rates in both groups. METHODS: This retrospective cohort study included adult patients admitted to the intensive care unit of King Fahad Hospital of the University, Alkhobar, Saudi Arabia, between March 1 and October 31, 2020. This study compared and analyzed the outcomes of delayed tracheostomy in patients with and without COVID-19 in terms of complication, morbidity, and mortality rates. RESULTS: Of the 228 study participants, 111 (48.68%) had COVID-19. The mean age of the study participants was 58.67 years (SD = 17.36, max.=93, min.=20), and the majority were males (n = 149, 65.35%). Regarding tracheostomy in patients with COVID-19, 11 (9.91%) patients underwent tracheostomy; however, four (36.36%) of them had prolonged intubation. The mean intensive care unit admission length of stay for tracheostomy patients was 37.17 days, while it was 12.09 days for patients without tracheostomy (t(226)=-9.32, p < 0.001). Regarding prolonged intubation among patients with COVID-19 (n = 7, 6.31%), the complications were as follows: six people (85.71%) had dysphonia, one (14.29%) had vocal cord granuloma, and two (28.57%) had subglottic tracheal stenosis. The mortality rate among our study participants was 51.32%, and the risk was significantly higher in older people (Odds ratio = 1.04, 95% Confidence Interval [CI] = 1.02-1.06) and in delayed tracheostomy cases (OR = 2.95, 95% CI = 1.31-6.63). However, COVID-19 status was not significantly related to the risk of mortality. CONCLUSIONS: Delaying tracheostomy increases the risk of mortality. Therefore, we recommend weighing the risks and benefits for each patient to benefit both healthcare workers and patients with COVID-19.

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Erythema nodosum (EN) is a skin lesion that presents due to an inflammation of the subcutaneous fat, which is manifested clinically as a sudden onset of tender erythematous lesions. These lesions are typically localized to the pretibial surface. The cause of EN is mainly idiopathic, other causes are drugs, infections, autoimmune diseases, and inflammatory bowel disease. As vaccines are rarely known to cause EN, we are reporting a case of a 19-year-old female with a delayed recurrent reaction following the second dose of the COVID-19 vaccine.

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INTRODUCTION: Tobacco use has changed since the onset of the coronavirus disease (COVID-19) pandemic. The effect of smoking on COVID-19 susceptibility has not yet been determined. In this study, we aimed to assess the association between smoking and COVID-19 susceptibility. METHODS: This retrospective case-control study was conducted at the quarantine center of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, between April and June 2020. A total of 142 adults participated in the study, 73 of whom tested positive for COVID-19 and were matched for both sex and age with participants in the control group. Telephone interviews were conducted to assess the risk factors associated with that exposure. RESULTS: Different variables are investigated for their impact on COVID-19 infection susceptibility. The current study's findings indicated that smokers comprised only 27.5% (n=39) of the participants. There was no association between the COVID-19 swab results and smoking status (χ2=1.857; p=0.395). Furthermore, there was no significant association between any of the smoking parameters and susceptibility to COVID-19, except for the smoking period (t= -2.105, p=0.041). The odds of having a positive swab result among cigarette smokers were lower than those among pipe, waterpipe, and electronic cigarette smokers (OR=0.600; p=0.394). An association was also observed between COVID-19-positive swab results and contact with an individual with COVID-19 or respiratory disease (χ2=79.270 and χ2=18.929, respectively, p≤0.001). CONCLUSIONS: This study revealed no association between smoking status and COVID-19 swab test results. Further research with a bigger sample size is suggested to confirm the relationship between smoking and COVID-19 susceptibility.

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BACKGROUND: Physical activity is a known preventive measure for many worldwide public health issues. The purpose of this study is to assess the association between physical activity and the susceptibility to COVID-19 infection. PATIENTS AND METHODS: This was a retrospective matched case-control study involving adult participants quarantined with IAU, Dammam, Saudi Arabia. The total randomized sample of study participants were 142, in which 73 of them were tested positive for COVID-19 test and matched for both age and sex with their respective healthy controls who tested negative for COVID-19 test to determine the risk associated with that exposure. RESULTS: Several variables are assessed regarding their influence on the susceptibility of COVID-19 infection. Exactly half indicated that they were physically active (n = 71). Physical activity did not show any significant association with COVID-19 contraction (x 2= 0.254, P= 0.614) nor self-rated level of physical activity (x 2= 0.122, P= 0.727). Less than half of the participants who had contact with a COVID-19 patient within 14 days of admission to quarantine appeared to have a significantly higher incidence of positive COVID-19 swab results compared to those who did not (x 2= 27.121, P= <0.001). While third of the participants who indicated that they have had a contact with someone who have Respiratory symptoms or fever within 14 days before admission were tested positive for COVID-19. Participants with lower educational degrees are more likely to be infected with COVID-19. While the rest of the demographic variables appear to be not significantly related to the likelihood of being COVID-19 infected, these include gender, marital status, employment status, age, and BMI. CONCLUSION: The present study showed no significant association between physical activity and susceptibility to COVID-19 infection. We recommend a larger sample size to further clarify the relationship between other variables and susceptibility of COVID-19.

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In the field of hybrid natural fiber polymer composites, there has been a recent surge in research and innovation for structural applications. To expand the strengths and applications of this category of materials, significant effort was put into improving their mechanical properties. Hybridization is a designed technique for fiber-reinforced composite materials that involves combining two or more fibers of different groups within a single matrix to manipulate the desired properties. They may be made from a mix of natural and synthetic fibers, synthetic and synthetic fibers, or natural fiber and carbonaceous materials. Owing to their diverse properties, hybrid natural fiber composite materials are manufactured from a variety of materials, including rubber, elastomer, metal, ceramics, glasses, and plants, which come in composite, sandwich laminate, lattice, and segmented shapes. Hybrid composites have a wide range of uses, including in aerospace interiors, naval, civil building, industrial, and sporting goods. This study intends to provide a summary of the factors that contribute to natural fiber-reinforced polymer composites' mechanical and structural failure as well as overview the details and developments that have been achieved with the composites.

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Posttraumatic stress disorder (PTSD) is a psychiatric diagnosis made when someone including children who experiences traumatic stressor. Those who are exposed to a more severe trauma have highest level of PTSD. The aim of this study was to measure the prevalence of PTSD and its associated factors among 219 children who were affected by a form of natural disaster which is the tsunami waves in a rural area in Malaysia. A cross sectional study was carried out among children aged 10-12 years 6 months after the traumatic event. Child Posttraumatic Stress Disorder –Reaction Index (CPTSD-RI) was used as a screening instrument which was answered by the affected children through a self-administered questionnaire. Forty six percent of these children had PTSD symptoms; 31.1% of these children had mild, 11.4% had moderate, 3.7% had severe PTSD and none had very severe PTSD. Result also showed that 91.8% had re-experiencing symptoms, 28.3% had numbing/avoidance symptoms and 49.3% had hyperarousal symptoms. Children with low social support (Adj OR = 2.3 (95% CI: = 1.3- 4.2)), and children who experienced deaths among someone close to them (Adj OR = 3.7 (95% CI =1.2 - 11.5)) were more likely to have symptoms of PTSD. This showed that children are at higher risk of developing PTSD as early as 6 months after the event and thus early intervention should be offered to them. Future longitudinal study can be carried out among affected children to assess whether these PTSD symptoms persist over time.

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Introduction: Anemia in pregnancy is still a public health problem in developing countries including Malaysia. Early screening of pregnant mothers who have risk factors of anemia could help identifying these potential anemic mothers and hence targeted for intervention. Methodology: A cross sectional study IN 2008 was conducted among pregnant women who attended government health clinics in Johor Bahru district to assess the prevalence of anemia in pregnancy and factors associated with it using a structured questionnaire. Result: Prevalence of anemia in pregnancy (Hb<11.0 g/dl) was 36.6% and majority in mild category (Hb 9-<11 g/dl). The associated factors of anemia in pregnancy were birth spacing, dietary intake with high iron content and iron pill consumption. Multivariate analyses revealed that iron pill intake was the most important factor influencing anemia in pregnancy. Discussion and conclusion: Even though Johor Bahru is a big town with good health facilities, the prevalence of anemia in pregnancy was quite high. Results were compared with previous studies. Emphasis on compliance to iron pills is very important in prevention and treating anemia in pregnancy

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OBJECTIVES: This qualitative study was aimed at exploring the perceptions of community leaders and mothers about health services and community actions pertaining to child health in Lahej, Yemen since the Implementation of Integrated Management of Childhood Illnesses (IMCI) in 2003. METHODS: Face-to-face, semi-structured, in-depth interviews were conducted with six community leaders and seven mothers in 2007 in the three districts of Lahej Governorate, Yemen, that are implementing IMCI. RESULTS: Neither group was aware of IMCI, but had "positive perception to the services." Community leaders expressed "uncertainty about the role of health committees and community participation," and said, "people can contribute in different ways" and "health authorities must play a more active role." The mothers emphasised, "poor livelihood and environmental conditions" and "salient counselling messages not received." CONCLUSION: The pressing needs for effective community-IMCI is obvious owing to the appalling toll on child health of unfavourable livelihood and environmental conditions and disorganised community initiatives. Thus, for effective IMCI implementation, governmental support needs to be strengthened.

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Depressive illness is common among the aged population. A case control study was conducted, focusing on risk factors influencing depression among the elderly. This study involved 130 elderly patients diagnosed to have depressive illness from the psychiatric clinics of Kuala Lumpur Hospital (HKL) and Universiti Kebangsaan Malaysia Hospital (HUKM). Another group of 130 elderly patients with no history of depressive illness were recruited from the medical specialist clinics. The majority of cases were female (75.4%), aged 60-74 years (92.3%) and from Chinese ethnic group (59.2%). Non-Malay elderly has three times risk (AOR 2.537, 95% CI 1.439-4.471) of suffering the depressive illness compared to the Malay elderly, the elderly with chronic health problems are more likely to be depressed compared to those who do not suffer from any chronic illness (p trend <0.001). Other risk factors identified were family history of depression with four times risk (AOR 4.225, 95% CI 2.017-8.848) and lower social support with eight times risk (AOR 7.949, 95% CI 2.588-24.417). Social support is not only important in encouraging the elderly to practice healthy life style but proven to influence the risk of getting depression among them. Hence, it is very crucial that the elderly is given total attention, respect and love from all parties to ensure prosperity and meaningfulness in life.

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Giardia duodenalis causes diarrhoea and malabsorption. The objectives of the study were to detect local isolates of G. doudenalis by polymerase chain reaction (PCR) and to determine their restriction fragment length polymorphisms (RFLP). G. doudenalis isolated from stools of patients from Hospital Orang Asli Gombak were cultured axenically using TYI-S-33 medium with 10% foetal calf serum. The commercially designed primer-pair 432/433 was used to amplify a 0.52 kb segment known to encode the homologous cysteine-rich trophozoite surface antigen (tsp11 and tsa417). Results showed that the primer-pair 432/433 could amplify the target region of the local isolates. RFLP study on the identical isolates showed that all the restriction enzymes tested ( HindIII, ClaI, PstI and Kpn) gave a banding pattern similar to that of the WB strain a reference pathogenic strain from human. The reference pathogenic strain were commercially obtained from the American Type Culture Collection (ATCC).

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Giardia duodenalis is an intestinal parasite that causes diarrhoea and malabsorption in children. The parasite also infects AIDS patients with a weak immune system. A study was carried out on six local isolates of Giardia duodenalis (110, 7304, 6304, M007, 2002 and 6307) from faeces of Orang Asli patients admitted to the Gombak Hospital. WB, a reference pathogenic strain from human and G. muris from a wild mouse, were commercially obtained from the American Type Culture Collection (ATCC). All the isolates were cultured axenically in TYI-S-33 medium. Two sets of primers were used for the techniques: primers LP1 and RP1 and primers LP2 and RP2. The sets of primers amplified giardine gene of 171 bp and 218 bp in sizes respectively. The study showed that the two sets of primers could detect G. duodenalis to the genus and species level specifically.

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