Review of Malaysian Tenth Health Plan 2011-2015

Malaysia is an energetic nation has appreciated monetary development on political soundness since his freedom. Malaysians are extra sound, have a more drawn out future and beneficial. The level of general health accomplished means that the achievement of the nation. Great health permits the nation to appreciate profitable and significant lifespan. Great health adds to the thriving and general social solidness. Tenth Malaysia Plan 2011-2015 has point by point on the health arrangement for country. There are 4 Technical Working Group was built up to deliver issues identified with health administrations conveyance, administration, and finance, health mindfulness and solid way of life and strengthening of individual and group to oversee own health

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Fabrication of reduced Graphene Oxide supported Gd\u3csup\u3e3+\u3c/sup\u3e doped V2O5 nanorod arrays for superior photocatalytic and antibacterial activities

In the current report, pure V2O5, a series of Gd doped V2O5 (1 wt%, 3 wt%, 5 wt% and 10 wt%) and graphene integrated Gd–V2O5 photocatalysts have been prepared using a facile wet chemical approach. The effect of Gd+3 ions substitution and RGO support on V2O5 was studied by the different analytical techniques. X-ray diffraction (XRD) results showed the orthorhombic crystal structure of synthesized samples with crystallize size in range of 22–35 nm. Morphological analysis showed nanorods and nanorod arrays like appearance of V2O5, Gd–V2O5 and GdV-2O5/RGO, respectively. Gd–V2O5 and Gd–V2O5/RGO exhibited enhanced optical response in the visible region along with decrease in the band gap values for Gd doped V2O5 samples. BET surface area of Gd–V2O5 and Gd- V2O5/RGO was calculated as 12.39 g/m2 and 15.35 g/m2 that was found to be higher than pristine V2O5. To study the photocatalytic activity of synthesized photocatalysts, methylene blue (MB) was chosen as model pollutant. Among the Gd doped V2O5 samples, highest photocatalytic activity (45.62%) was achieved by optimal concentration of 5 wt% Gd–V2O5 that is accredited to effective separation of electron-hole pairs. While Gd–V2O5/RGO showed 2.1 times higher dye removal (97.12%) than unsupported Gd–V2O5, under the visible light irradiation. The significantly high photocatalytic activity of Gd–V2O5/RGO is due to the synergistic effect aroused by combined action of Gd+3 ions doping and advantageous properties of highly conductive and large surfaced graphene. Recycling experiments for V2O5 derivatives showed good stability and recyclability of photocatalysts. Additionally, Gd–V2O5/RGO was found to be more potential anti-bacterial agent than V2O5 and Gd–V2O5

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc