AN ANALYSIS OF QUALITY CRITERIA TO DETERMINE THE IMPROVEMENT PRIORITY ATTRIBUTES

The focus of this study is on how to find out the improvement priorities for customer satisfaction. The identification, analysis, and evaluation conducted in this study is to the Voice of Customer (VoC) based on the service attributes of SERVQUAL.  To explore customer satisfaction, the survey distributed is through questionnaire developed using Kano method and Likert scale to the customers of event organizer in Selangor, especially the customers who are using their services for wedding events. While to find out what the attributes of service delivered as the elements for improvement required, the analysis conducted is through the integration of ranking level, customer satisfaction-dissatisfaction (CS-DS) values and graph, and their correlation. In this study, the statistical analysis conducted using SPSS is to construct the comparison between Kano method results against the quality attributes based on pairwise of Functional and Dysfunctional condition to find out the correlation and the relationship among the service elements identified. This study found that “The electronic service to communicate with customer (K1)” of the service attributes of “Responsiveness” is as the first priority improvement required by customer

Multilocus Sequence Typing Reveals Extensive Genetic Diversity of the Emerging Fungal Pathogen Scedosporium aurantiacum

Scedosporium spp. are the second most prevalent filamentous fungi after Aspergillus spp. recovered from cystic fibrosis (CF) patients in various regions of the world. Although invasive infection is uncommon prior to lung transplantation, fungal colonization may be a risk factor for invasive disease with attendant high mortality post-transplantation. Abundant in the environment, Scedosporium aurantiacum has emerged as an important fungal pathogen in a range of clinical settings. To investigate the population genetic structure of S. aurantiacum, a MultiLocus Sequence Typing (MLST) scheme was developed, screening 24 genetic loci for polymorphisms on a tester strain set. The six most polymorphic loci were selected to form the S. aurantiacum MLST scheme: actin (ACT), calmodulin (CAL), elongation factor-1α (EF1α), RNA polymerase subunit II (RPB2), manganese superoxide dismutase (SOD2), and β-tubulin (TUB). Among 188 global clinical, veterinary, and environmental strains, 5 to 18 variable sites per locus were revealed, resulting in 8 to 23 alleles per locus. MLST analysis observed a markedly high genetic diversity, reflected by 159 unique sequence types. Network analysis revealed a separation between Australian and non-Australian strains. Phylogenetic analysis showed two major clusters, indicating correlation with geographic origin. Linkage disequilibrium analysis revealed evidence of recombination. There was no clustering according to the source of the strains: clinical, veterinary, or environmental. The high diversity, especially amongst the Australian strains, suggests that S. aurantiacum may have originated within the Australian continent and was subsequently dispersed to other regions, as shown by the close phylogenetic relationships between some of the Australian sequence types and those found in other parts of the world. The MLST data are accessible at http://mlst.mycologylab.org. This is a joined publication of the ISHAM/ECMM working groups on “Scedosporium/Pseudallescheria Infections” and “Fungal Respiratory Infections in Cystic Fibrosis”.Peer Reviewe

Life-threatening hypersplenism due to idiopathic portal hypertension in early childhood: case report and review of the literature

<p>Abstract</p> <p>Background</p> <p>Idiopathic portal hypertension (IPH) is a disorder of unknown etiology and is characterized clinically by portal hypertension, splenomegaly, and hypersplenism accompanied by pancytopenia. This study evaluates the pathogenic concept of the disease by a systematic review of the literature and illustrates novel pathologic and laboratory findings.</p> <p>Case Presentation</p> <p>We report the first case of uncontrolled splenic hyperperfusion and enlargement with subsequent hypersplenism leading to life-threatening complications of IPH in infancy and emergent splenectomy.</p> <p>Conclusions</p> <p>Our results suggest that splenic NO and VCAM-1, rather than ET-1, have a significant impact on the development of IPH, even at a very early stage of disease. The success of surgical interventions targeting the splenic hyperperfusion suggests that the primary defect in the regulation of splenic blood flow seems to be crucial for the development of IPH. Thus, beside other treatment options splenectomy needs to be considered as a prime therapeutic option for IPH.</p

The value of c-reactive protein/albumin ratio in the severity and mortality in COVID-19 patients

The continuing coronavirus disease 2019 (COVID-19) pandemic provides several concerns for physicians. Thus, saving maximum lives as possible and finding people at risk of serious problems is essential. This study aimed to determine the association of CRP/albumin ratio with severity, duration of hospital stay and mortality in COVID-19 patients. The patient aged 18 to 80 with positive COVID-19 at Hospital Raja Perempuan Zainab II (HRPZ II), Kota Bharu, Kelantan, with available CRP/albumin ratio data on admission, were retrospectively evaluated from March 2021 to March 2022. Disease severity was categorized based on Annex 2e guidelines by Malaysia's Ministry of Health, which further classified them into mild to moderate disease (Stage 1-3) and severe to critical illness (Stage 4- 5). The CRP/albumin ratio levels on Day 1 admission were archived from the electronic medical record system and compared between the two groups. The study included 141 COVID-19 patients with a mean age of 51.11(SD± 16.66) for mild to moderate and 58.06 (SD± 13.87) for severe to critical. The severe to critical group had significantly higher values of patients’ age (p=0.015). The frequency of patients according to severity, 36(26%) were mild to moderate, and 105(74%) were severe to critical. CRP/Alb ratio was significantly elevated in the severe to critical illness group (p<0.001). 28 (20%) patients died, 113 (80%) survived, and median CRP/albumin ratio values were higher in non-survivors compared to survivors (p<0.001). High CRP/albumin ratio levels were associated with longer hospital stay (correlation coefficients 0.295, p<0.001). Receiver operator characteristic analysis showed that the area under the curve (AUC) for CRP/albumin ratio was 0.755 (95% CI: 0.670- 0.840). The optimal cut-off point of CRP/albumin ratio was 1.494 (sensitivity 60%, specificity 89%, PPV 0.94, NPV 0.43, LR+ 5.41, LR- 0.45, DOR 12). CRP/Alb ratio on Day 1 admission is associated with COVID-19 severity and mortality

Molecular Typing of Australian Scedosporium Isolates Showing Genetic Variability and Numerous S. aurantiacum

Molecular typing showed genetic diversity, dismissed 2 suspected outbreaks of scedosporiosis, and identified multiple strains of the newly described species S. aurantiacum

Analysis of sequence variations in low-density lipoprotein receptor gene among Malaysian patients with familial hypercholesterolemia

<p>Abstract</p> <p>Background</p> <p>Familial hypercholesterolemia is a genetic disorder mainly caused by defects in the low-density lipoprotein receptor gene. Few and limited analyses of familial hypercholesterolemia have been performed in Malaysia, and the underlying mutations therefore remain largely unknown.</p> <p>We studied a group of 154 unrelated FH patients from a northern area of Malaysia (Kelantan). The promoter region and exons 2-15 of the LDLR gene were screened by denaturing high-performance liquid chromatography to detect short deletions and nucleotide substitutions, and by multiplex ligation-dependent probe amplification to detect large rearrangements.</p> <p>Results</p> <p>A total of 29 gene sequence variants were reported in 117(76.0%) of the studied subjects. Eight different mutations (1 large rearrangement, 1 short deletion, 5 missense mutations, and 1 splice site mutation), and 21 variants. Eight gene sequence variants were reported for the first time and they were noticed in familial hypercholesterolemic patients, but not in controls (p.Asp100Asp, p.Asp139His, p.Arg471Gly, c.1705+117 T>G, c.1186+41T>A, 1705+112C>G, Dup exon 12 and p.Trp666ProfsX45). The incidence of the p.Arg471Gly variant was 11%. Patients with pathogenic mutations were younger, had significantly higher incidences of cardiovascular disease, xanthomas, and family history of hyperlipidemia, together with significantly higher total cholesterol and low density lipoprotein levels than patients with non-pathogenic variants.</p> <p>Conclusions</p> <p>Twenty-nine gene sequence variants occurred among FH patients; those with predicted pathogenicity were associated with higher incidences of cardiovascular diseases, tendon xanthomas, and higher total and low density lipoprotein levels compared to the rest. These results provide preliminary information on the mutation spectrum of this gene among patients with FH in Malaysia.</p

Redesign business model of masjid kitchens as soup kitchens, providing jobs employment and nurturing of asnaf as entrepreneurs, and income generation for the masjid

A survey conducted by the Department of Statistics Malaysia in May 2020 has found that: (a) 46.6% of self-employed respondents had reported losing their jobs; (b) an estimated 90% respondents were still working with lower than usual salaries; (c) more than two-thirds (71.4%) of self-employed respondents have sufficient financial savings for less than one month; and (d) the majority of respondents said they are unprepared if the duration of the MCO was extended except for employees under Government Linked Companies and multinational companies. In the “Families on The Edge” UNICEF report dated October 2020, COVID-19 crisis has pushed more low-income (or B40) urban Malaysian families into poverty. The poverty rate in the B40 community is higher than last year, with 50% of the families now living in absolute poverty. 70% of these households reported that COVID-19 had affected their ability to meet their basic living expenses, with 37% reporting that they struggle to purchase enough food for their families while 35% are unable to pay their bills on time. Hence, the main objectives of this paper is to offer a conceptual business model in turning masjid kitchens (or mKitchen) as a potential (a) soup kitchen for the B40 and Asnaf community, (b) job employment and nurturing of the Asnaf as entrepreneurs, and (c) income generation for the masjid via rental of kitchens. This is to turn the Asnaf community ‘Dari Penerima Zakat ke Pembayar Zakat’. The conceptual mKitchen business model can be adapted for possible implementation by masjid or mosques

Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural Malaysia, a middle income country

<p>Abstract</p> <p>Background</p> <p>The prevalence and correlates of physical disability and functional limitation among older people have been studied in many developed countries but not in a middle income country such as Malaysia. The present study investigated the epidemiology of physical disability and functional limitation among older people in Malaysia and compares findings to other countries.</p> <p>Methods</p> <p>A population-based cross sectional study was conducted in Alor Gajah, Malacca. Seven hundred and sixty five older people aged 60 years and above underwent tests of functional limitation (Tinetti Performance Oriented Mobility Assessment Tool). Data were also collected for self reported activities of daily living (ADL) using the Barthel Index (ten items). To compare prevalence with other studies, ADL disability was also defined using six basic ADL's (eating, bathing, dressing, transferring, toileting and walking) and five basic ADL's (eating, bathing, dressing, transferring and toileting).</p> <p>Results</p> <p>Ten, six and five basic ADL disability was reported by 24.7% (95% CI 21.6-27.9), 14.4% (95% CI 11.9-17.2) and 10.6% (95% CI 8.5-13.1), respectively. Functional limitation was found in 19.5% (95% CI 16.8-22.5) of participants. Variables independently associated with 10 item ADL disability physical disability, were advanced age (≥ 75 years: prevalence ratio (PR) 7.9; 95% CI 4.8-12.9), presence of diabetes (PR 1.8; 95% CI 1.4-2.3), stroke (PR 1.5; 95% CI 1.1-2.2), depressive symptomology (PR 1.3; 95% CI 1.1-1.8) and visual impairment (blind: PR 2.0; 95% CI 1.1-3.6). Advancing age (≥ 75 years: PR 3.0; 95% CI 1.7-5.2) being female (PR 2.7; 95% CI 1.2-6.1), presence of arthritis (PR 1.6; 95% CI 1.2-2.1) and depressive symptomology (PR 2.0; 95% CI 1.5-2.7) were significantly associated with functional limitation.</p> <p>Conclusions</p> <p>The prevalence of physical disability and functional limitation among older Malaysians appears to be much higher than in developed countries but is comparable to developing countries. Associations with socio-demographic and other health related variables were consistent with other studies.</p