Melioidosis: a rare cause of anterior chest wall abscess

AbstractMelioidosis is an unusual tropical infectious disease caused by the gram-negative bacterium Burkholderia pseudomallei, which was formerly known as Pseudomonas pseudomallei. Melioidosis is characterized by abscess formation and it may manifest in any part of the human body, however, musculoskeletel melioidosis is uncommon and chest wall melioidosis is very rare. To determine the exact organism based solely on clinical presentation poses a great challenge to the physician. Yet, delay administration of antibiotic may be harmful. We describe a diabetic patient who had anterior chest wall melioidosis that mimics Staphylococcus aureus infection. A description of his presentation and management, along with a review of literature is presented

The impact of COVID-19 non-pharmaceutical interventions on the lived experiences of people living in Thailand, Malaysia, Italy and the United Kingdom: A cross-country qualitative study.

This qualitative study explores the impact of non-pharmaceutical interventions (NPIs), including social distancing, travel restrictions and quarantine, on lived experiences during the first wave of the COVID-19 pandemic in Thailand (TH), Malaysia (MY), Italy (IT) and the United Kingdom (UK). A total of 86 interviews (TH: n = 28; MY: n = 18; IT: n = 20; UK: n = 20) were conducted with members of the public, including healthcare workers (n = 13). Participants across countries held strong views on government imposed NPIs, with many feeling measures lacked clarity. Most participants reported primarily negative impacts of NPIs on their lives, including through separation, isolation and grief over missed milestones; work-related challenges and income loss; and poor mental health and wellbeing. Nonetheless, many also experienced inadvertent positive consequences, including more time at home to focus on what they most valued in life; a greater sense of connectedness; and benefits to working life. Commonly employed coping strategies focused on financial coping (e.g. reducing spending); psycho-emotional coping (e.g. engaging in spiritual practices); social coping and connectedness (e.g., maintaining relationships remotely); reducing and mitigating risks (e.g., changing food shopping routines); and limiting exposure to the news (e.g., checking news only occasionally). Importantly, the extent to which participants' lived experiences were positive or negative, and their ability to cope was underpinned by individual, social and economic factors, with the analysis indicating some salient differences across countries and participants. In order to mitigate negative and unequal impacts of NPIs, COVID-19 policies will benefit from paying closer attention to the social, cultural and psychological-not just biological-vulnerabilities to, and consequences of public health measures

Social, ethical and behavioural aspects of COVID-19.

Introduction: Vaccines and drugs for the treatment and prevention of COVID-19 require robust evidence generated from clinical trials before they can be used. Decisions on how to apply non-pharmaceutical interventions such as quarantine, self-isolation, social distancing and travel restrictions should also be based on evidence. There are some experiential and mathematical modelling data for these interventions, but there is a lack of data on the social, ethical and behavioural aspects of these interventions in the literature. Therefore, our study aims to produce evidence to inform (non-pharmaceutical) interventions such as communications, quarantine, self-isolation, social distancing, travel restrictions and other public health measures for the COVID-19 pandemic. Methods: The study will be conducted in the United Kingdom, Italy, Malaysia, Slovenia and Thailand. We propose to conduct 600-1000 quantitative surveys and 25-35 qualitative interviews per country. Data collection will follow the following four themes: (1) Quarantine and self-isolation (2) social distancing and travel restrictions (3) wellbeing and mental health (4) information, misinformation and rumours. In light of limitations of travel and holding in-person meetings, we will primarily use online/remote methods for collecting data. Study participants will be adults who have provided informed consent from different demographic, socio-economic and risk groups. Discussion: At the time of the inception of the study, United Kingdom, Italy, Malaysia, Slovenia and Thailand have initiated strict public health measures and varying degrees of "lockdowns" to curb the pandemic. These public health measures will change in the coming weeks and months depending on the number of cases of COVID-19 in the respective countries. The data generated from our study could inform these strategies in real time

Factors influencing attitude toward organ and tissue donation among patients in primary clinic, Sabah, Malaysia

Introduction Worldwide, the gap between organ supply and demand has widened over the years. Malaysia has one of the lowest deceased organ donation rates. Success rate of organ or tissue procurement depends on not only the approach rate by health care providers but also the awareness among the public, whereby it can be a platform for family initiation of organ donation. The purpose of this study is to assess the knowledge of and determine the factors influencing attitude toward organ and tissue donation among patients in a primary clinic. Methods A cross-sectional analytical study was carried out. Self-administered questionnaires were given to 400 patients who registered at an outpatient clinic in April 2018. Convenience sampling was applied. Results Monthly income, education level, occupation, and knowledge level are significantly associated with attitude of the respondents toward organ and tissue donation. Occupation influenced attitude toward organ donation. Knowledge of organ donation and brain death both significantly affected attitude toward organ donation. Conclusion The greater the knowledge of organ donation and brain death, the more positive impression or attitude toward organ donation. Education level and income are the main predictors that influence attitude toward organ donation. Hence, it is important for public health units to promote and deliver public education on organ donation, change public misconceptions, and work parallel with hospitals to increase organ donation rates in Sabah. Previous articleNext article Worldwide, the gap between organ supply and demand has widened over the years. Malaysia has one of the lowest deceased organ donation rates (0.7 donations per million population) compared with countries such as Spain, which had the highest with a donation rate of 36 per million population in 2014. Other Asian countries are not far off from Malaysia, such as Myanmar (0.02) and Thailand (1.26) [1]. The World Health Organization defines transplantation as the transfer of human cells, tissues, or organs from a donor to a recipient with the aim of restoring functions in the body [2]. In Sabah, the Sabah Regional Transplant Procurement Management Unit has made effort for all government hospitals in Sabah to have a Tissue Organ Procurement team for identification and referral of eligible cases. Sabah is a Malaysian state with a high number of potential cadaveric or deceased donors for referral, but the consent for organ donation is still low. Transplantation is the only hope and definitive treatment for patients with organ failure. Donors can be either living or deceased. Unlike a deceased donor or cadaveric donor, a living donor can only donate part of the liver, 1 kidney, and bone marrow. A cadaveric donor can donate more organs and tissues without giving risk to the donor. Thus, a cadaveric donor is a preferable type of donor; however, cadaveric donation is very low in Malaysia. In 2015, Malaysia had its highest number of cadaveric donors, but Sabah only contributed 1 donor. The whole Malaysia had 35 cadaveric donors in 2017. Among them only 1 donor was from Sabah state. The demand and supply cannot meet up due to the lack of organs. Since 1998, the Malaysia Ministry of Health has initiated a number of activities to promote the development of organ donation and transplantation. Many countries have faced a similar problem of organ shortage for transplantation in patients with end-stage organ failure. Organ transplantation is the only hope for patients with end-stage organ failure to improve their quality of life. If a cadaveric organ donation program is not supported by the community, this may end up in organ trafficking. If the family of the deceased has a lack of knowledge of organ donation and the procurement process, this will lead to refusal in donating the organs and tissues. The deceased’s family’s consent is the last step in organ harvesting. Hence, it is important for public health units to promote and deliver public education on organ donation, change public misconceptions, and work together with hospitals to increase organ donation rates in Sabah. The purpose of this study is to determine the factors influencing attitude toward organ and tissue donation among patients, and to assess the knowledge of organ donation and brain death among patients. Methods A cross-sectional analytical study was conducted at primary health clinic Kota Kinabalu, from October 2017 to July 2018 with a total of 10 months’ duration. It is located in Sabah state in Malaysia and is under the lead of 1 family medicine specialist with 15 medical officers. Monthly patients in outpatient clinic range from 4000 to 6000. The study population targeted is registered patients more than 18 years old who visited an outpatient clinic during the study period. Data collection was done during working hours until the preferable sample size was obtained. Nonprobability convenience sampling was used. Respondents who were selected followed the Queue Management Server (QMS) numbering system from number 1 to the end of the day. Those respondents who agreed to participate were given a self-administered questionnaire. The entire questionnaire was placed at the registration counter and distributed together with the QMS number before seeing the doctor. A sample size of 383 patients was taken by calculating the pilot study samples using the Sample Size Calculator for Prevalence Studies (SSCPS version 1.0.03). All the registered patients who agreed to participate and were above 18 years old were included in the study. Patients who were not registered or had no document or refused or were less than 18 years old were excluded from the study. Respondents could choose to withdraw at any time. The items in the questionnaire for the knowledge part were mainly modified from the study by Ozturk Emiral et al [3]. This was to ensure the items were appropriate and able to be answered by respondents. The Malay version of the questionnaire was pilot tested by the patients from the Emergency and Trauma Department 1 month before data collection. Thirty respondents were obtained by using patients grouped in the green zone at the Emergency and Trauma Department for reliability test. These 30 samples were not included in the study. Cronbach’s alpha was used to determine the internal consistency of the scale on 12 knowledge and exposure questions in Part B and 11 questions on attitude toward organ and tissue donation in Part C of the questionnaires. A total of 23 items were tested for reliability. Cronbach’s alpha for the overall scale was 0.870. There are a total of 36 questions in the questionnaires, which can be divided into the following 3 parts: Part A: Sociodemographic characteristics; Part B: Exposure and knowledge in organ donation and brain death; and Part C: Acceptance or attitudes toward organ donation. After the questionnaire was pilot tested and obtained acceptable reliability testing, the questionnaires were distributed to the study population. The questionnaire was validated before the main study was done. Descriptive analysis was done by using frequencies, and the χ2 test was used to determine association between sociodemographic characteristics and attitude toward organ donation, and to study the association between knowledge levels of the respondents toward attitude for organ donation. Statistical analysis was performed using SPSS version 22 (IBM, Armonk, NY, United States) throughout the study. Results A total of 400 self-administered questionnaires were distributed, of which 383 (95.75%) were successfully completed. Most of the respondents had secondary educations, which consisted of 337 respondents (88%) compared with primary education of 46 (12%). A total of 313 (81.7%) were aged less than 40 years, and 70 (18.3%) of the total respondents were aged over 40 years. The mean age for the sample was 32.69 ± 9.239. Most of the respondents, 193 (50.4%), had monthly income of at least RM2000. A total of 151 (39.4%) of the respondents were government servants. Most were married 251 (65.5%). Respondents consisted of 155 (40.5%) men and 228 (59.5%) women. Knowledge of Organ Donation A total of 339 (88.8%) respondents answered the first question correctly, which asked about the organ donation definition. For the second question, which is the age limit for organ donation, only 178 (46.5%) respondents answered correctly that there was no age limit for organ donation. Most of the respondents, 292 (76.2%), answered correctly for causes of organ transplant. Respondents correctly answered for organ transplant causes with the statement, “High blood pressure and diabetes are common causes for people to require a kidney transplant.” A total of 307 (80.2%) respondents answered correctly what organs can be donated in Malaysia (kidneys, liver, heart, and lung), whereas 211 (55.1%) respondents answered correctly what tissues can be donated in Malaysia (bone, skin, heart valves, and cornea) (Table 1). Based on organ donation knowledge questions, responses were further categorized into good and poor knowledge of organ donation. One correct answer for 1 question was considered 1 mark, thus the maximum mark for this section was 5 marks and the lowest was 0 marks, with none of the questions answered correctly. We considered respondents with ood knowledge of organ donation to be those who answered correctly for 4 questions and above (4 and 5 marks), whereas those poor knowledge answered correctly for 3 questions and below. A total of 213 (55.6%) had good knowledge of organ donation, whereas the other 170 (44.4%) respondents had poor knowledge of organ donation (Table 2)

Economic and social impacts of COVID-19 and public health measures: results from an anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia.

OBJECTIVES: To understand the impact of COVID-19 and public health measures on different social groups, we conducted a mixed-methods study in five countries ('SEBCOV-social, ethical and behavioural aspects of COVID-19'). Here, we report the results of the online survey. STUDY DESIGN AND STATISTICAL ANALYSIS: Overall, 5058 respondents from Thailand, Malaysia, the UK, Italy and Slovenia completed the self-administered survey between May and June 2020. Poststratification weighting was applied, and associations between categorical variables assessed. Frequency counts and percentages were used to summarise categorical data. Associations between categorical variables were assessed using Pearson's χ2 test. Data were analysed in Stata 15.0 RESULTS: Among the five countries, Thai respondents reported having been most, and Slovenian respondents least, affected economically. The following factors were associated with greater negative economic impacts: being 18-24 years or 65 years or older; lower education levels; larger households; having children under 18 in the household and and having flexible/no income. Regarding social impact, respondents expressed most concern about their social life, physical health, mental health and well-being.There were large differences between countries in terms of voluntary behavioural change, and in compliance and agreement with COVID-19 restrictions. Overall, self-reported compliance was higher among respondents who self-reported a high understanding of COVID-19. UK respondents felt able to cope the longest and Thai respondents the shortest with only going out for essential needs or work. Many respondents reported seeing news perceived to be fake, the proportion varying between countries, with education level and self-reported levels of understanding of COVID-19. CONCLUSIONS: Our data showed that COVID-19 and public health measures have uneven economic and social impacts on people from different countries and social groups. Understanding the factors associated with these impacts can help to inform future public health interventions and mitigate their negative consequences. TRIAL REGISTRATION NUMBER: TCTR20200401002

Hand Grenade Blast Injuries: An Experience in Hospital Universiti Sains Malaysia

Hand grenade explosion is a rare occasion in our local community. Most of us have seen or heard about the injuries only from the TV news or newspaper. We report two cases of bomb blast injury that occurred in an army camp in September 2000. These case studies illustrate the clinical presentations of hand grenade blast injures that present with multiple organ involvement. We would like to share our experience in managing such cases in a busy emergency department and highlight the outcome of those two cases. Certain issues pertaining to the complexity of the injuries and mass casualty management are also highlighted

Barriers to the identification of possible organ donors among brain-injured patients admitted to intensive care units

Background: Improving organ donation rates requires better detection of possible organ donors, which in turn necessitates identifying barriers preventing the identification of possible organ donors. The objectives of this study were to determine the actual rate of possible deceased organ donors among nonreferred cases and to identify barriers to their identification as possible donors. Methods: This retrospective observational study used 6 months of data collected from two intensive care units (ICUs). Possible organ donors were defined as patients with a Glasgow Coma Scale score <5 and evidence of severe neurological damage. Barriers that led to the nonidentification of these patients as possible organ donors were also identified. Results: Fifty-six of 819 patients admitted to the ICUs during the study period were detected as possible organ donors, representing a 6.83% possible organ donor detection rate. Nonclinical barriers to the identification of possible organ donors were found to be more significant than clinical barriers (55% vs. 45%, respectively). The most significant nonclinical barrier was an unknown reason, despite patients being medically suitable for deceased organ donation and fulfilling the criteria for possible organ donor classification. Unresolved sepsis was the main clinical barrier. Conclusions: The significant rate of unreferred possible deceased organ donors found in this study reveals the need to increase awareness and knowledge among clinicians of the proper detection of possible donors at an early stage to avoid the loss of possible deceased organ donors, and thereby increase the deceased organ donation rate in Malaysian hospitals

Topic guide for qualitative study: Social, ethical and behavioural aspects of COVID-19

This is the topic guide for the protocol entitled "Social, ethical and behavioural aspects of COVID-19 (SEBCOV)" which will be conducted in the UK, Italy, Malaysia and Thailand