Coronavirus disease 2019 (COVID-19), a multisystemic disorder caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with both venous and arterial thromboses. The hypercoagulable state of the disease poses a challenge to the patient’s management. We herein report a case of acute ischaemic stroke in a COVID-19 patient who had been treated with three days of Baricitinib, an immunotherapy that can potentially augment the thrombotic risks. The case highlights the dilemma faced when initiating immunotherapy in a COVID-19 patient and emphasises the importance of evaluating the patient’s thrombotic risks, balanced against the benefit of immunotherapy, to facilitate the selection of ideal candidates for the immunotherapy.

Introduction Several countries have started mass vaccination programs to halt the spread of the COVID-19 pandemic. With an R naught value of 2 to 3, about 70% of the population needs to be immunized to achieve herd immunity. This study aimed to investigate the reasons for acceptance or refusal of COVID-19 vaccines among the Malaysian population. Methodology An exploratory, descriptive qualitative design was performed. The cross-sectional survey used a non-probability convenient sampling technique to recruit the respondents, who were required to answer an open-ended question: Either "If you are willing to get the vaccine, please state your reason" or "If you are not willing to get vaccinated, please state your reason." The survey also included questions on demography such as age, gender, and place of residence. According to the Health Belief Model, the data was transcribed, translated, and analyzed: perceived susceptibility, perceived severity, perceived barrier, and cues for action. Results A total of 1091 respondents who completed the online survey comprised 685 (62.8%) females, 406 (37.2%) males, with a mean age of 38.16 (SD = 16.44). The majority (81.1%) were willing to get vaccinated. Thematic analysis showed that most respondents perceived that the vaccine is safe, effective, protective and will provide herd immunity. Barriers to vaccination include unknown long-term side effects, rapid vaccine production, inadequate information and concerns regarding halal status. Cues to vaccination included individual desire, social responsibility, economic concerns and wait-and-see behavior. Conclusions The public should be well informed about the vaccine, its efficacy, side effects, and halal status to increase vaccine acceptability and achieve herd immunity.

Introduction: The world has been badly affected by the spread of a novel virus known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that was first reported in Wuhan, China back in December 2019. As the virus is transmitted through aerosol, respiratory droplets and close contact, hand hygiene and wearing mask are the most important preventive measures for COVID-19. Studies showed hand hygiene intervention improved compliances. This paper discussed the development of a hand hygiene intervention module, validation, usability and effectiveness reports. Methods: This study involved 5 stages; need analysis, module development, validation, usability and effectiveness studies. Need analysis and module development were carried out through brainstorming and literature search. The content was evaluated by three experts, whereas the usability was screened by four preschool teachers. The effectiveness of knowledge transfer was evaluated via pre and post intervention surveys. Results: The hand hygiene educational module received valuable comments from the content expert and the end-users (teachers). Knowledge score related to COVID-19 transmission, prevention and hand hygiene moments among pre-school children were significantly increased after the intervention. Conclusion: This module can be used to improve teaching method related to COVID-19 and hand hygiene. The ‘learn and play’ approach may increase excitement, thus make learning process enjoyable and memorable.

Introduction: Tropical herbs are used as a medicine long before the introduction of modern medicine, especially by traditional healers. However, its’ scientific benefits are not widely investigated. There is a belief that the use of traditional herbs potentially causing health deterioration due to its unknown mechanism of actions and interactions, and the nature of its unregulated processing as a health supplement. Parkia speciosa (local: petai) and Pithecellobium jiringa (local: jering) are two tropical herbs from the Leguminosae family that are widely used raw as salads with many perceived health benefits and harms. We reviewed both species, looking into scientific pieces of evidence supporting the belief. Methods: The databases of MEDLINE, PubMed, EBSCOhost, and Google Scholars were systematically searched for both in vitro and in vivo effects of both species with no language restriction. Data were extracted using standardised fashioned. Results: P speciosa has pharmacological properties including antioxidant and anti-inflammation. It has shown to have antibacterial properties and glucose-lowering activity. P jiringa contains known antioxidant metabolites such as flavonoids, phenolics and terpenoids. It also contains antiangiogenic properties with potential use in retinopathy, cancer, and Rheumatoid arthritis. However, both herbs have potentially harmful effects which include liver injuries. Large consumption of P jiringa leads to acute kidney injury. Conclusion: Consumption of both P speciosa and P jiringa has medicinal properties as well as health harm. If taken as a supplement, rigorous clinical trials are needed to delineate benefit vs harm effect of both herbs.

Background: COVID-19 is an emerging infectious disease caused by a novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In Malaysia, first few cases of COVID-19 were detected in January 2020, among Chinese nationals and the cases keep increasing day by day. Methods: This self-administered web based cross sectional study using Google forms was conducted among 400 Malaysian adults to explore their level of knowledge, attitude and practice towards COVID-19, as well as factors associated with the variables. Descriptive and binary logistic regression were performed using SPSS version 22. Results: Knowledge and practice among Malaysian adults towards COVID-19 were low. Gender (p = 0.030, OR:0.616, 95% CI 0.398-0.955) and occupation (p = 0.002, OR:2.489, 95% CI 1.485-4.172) were found as significant predictors of practice towards COVID-19. Conclusions: In conclusion, proper mass public health messages should be conducted by the higher authorities to improve knowledge and practice towards COVID-19.

Malaysian government started the Movement Control Order (MCO) on 18th March 2020, as one of the initiatives to prevent the more massive outbreak of COVID-19. Recent statistics showed a rapid rise in the numbers of positive COVID-19 patients. However, the statistics on COVID-19 patients being discharged showed that the higher authority was very committed in managing COVID-19 crisis. This online study was conducted among 1,543 Malaysian adults using a validated questionnaire to explore more ϑindings on the Malaysian’s Knowledge, Attitude and Practice (KAP) level towards COVID19 prevention during the MCO period. Descriptive study and binary logistic regression were performed using SPSS version 22. This study showed that the majority of respondents have good KAP level regarding COVID-19 prevention. WhatsApp and Telegram were the primary sources of information used by the respondents. Education level was the main predictor for knowledge (OR: 2.083, CI: 1.605-2.702), attitude (OR:1.854, Ci; 1.42-2.42) and practice (OR: 1.745, CI; 1.326-2.096) regarding COVID-19 prevention (p<0.001). Knowledge (OR; 1.636, CI: 1.302-2.054) and practice (OR;2.328, CI: 1.858- 2.916) were predictors of attitude regarding COVID-19 prevention (p<0.001). In conclusion, total adherence to the Movement Control Order (MCO) along with public health interventions focusing on behavioral change may play vital roles in breaking the chain of infection.

Introduction: Coronavirus Disease 2019, or better known as the COVID-19, has caused a global pandemic and high deathrate worldwide. Following the rapid increase of COVID-19 cases in Malaysia, the government had enforced Movement Control Order (MCO) started from 18 March 2020 and the restrictions were conducted and reviewed in several phases. The MCO also involved schools closure and commencement of online learning. This study aimed to identify the level of knowledge, attitudes and practices regarding COVID-19 among students in selected boarding schools in Malaysia. Methodology: This cross-sectional study was done in July to September 2020 using a set of questionnaire that was distributed via Google form. The questionnaire consisted of demographic data, knowledge, attitude and practice regarding COVID-19. The data was analysed using the Statistical Package for the Social Science 22. Results: A total of 365 students participated in this study. The respondents comprised of 54.2% female and 45.8% male students. The study found that they have moderate knowledge on COVID-19 while their attitude and practice were high. The study found a significant association between the knowledge and practice scores and between the attitude and practice scores of the respondents. [r = 0.389, p < 0.05] regarding COVID-19 However, there was no significant association between the knowledge and attitude scores. Conclusions: This study concluded that students' practice regarding COVID-19 was influenced by their attitude on health care to prevent COVID-19 infection. Therefore, changing their attitude and increasing the students knowledge are necessary to improve their practices regarding COVID-19 preventive measures.

Orthostatic tremor (OT) is one of the rare abnormal movement conditions characterized by leg tremors of 13-18 Hz upon standing and is often diminished upon walking or sitting. The exact pathophysiology of OT is still not fully understood, and it is uncertain whether the tremor causes unsteadiness on standing or vice versa. Treatment is a tremendous challenge. Medication toxicity with ineffective medications may likely cause distress to the patients and the physicians. Gabapentin, clonazepam, levodopa, and pregabalin are among the medications that have been used. We herein report on an elderly patient with OT, distressed, and anxious who improved significantly with physiotherapy as an adjunct therapy to the conventional medications.

Long COVID-19 is a constellation of symptoms following a confirmed COVID-19 acute infection. SARS-CoV-2 infection does not only give rise to respiratory problems but also other non-respiratory conditions. The symptoms and duration may vary among the patients and its treatment is based on the clinical presentation. Long COVID-19 among mildly infected patients was scarcely studied and reported, therefore we present a previously healthy, stage 2 COVID-19 patient who experiences prolonged symptoms of cough, chest pain, including anxiety and limited physical activities months after the first COVID-19 symptoms.

Multiple Sclerosis is an inflammatory demyelinating disease that affects the central nervous system, and is uncommon among the Asian population. It can present with a variety of symptoms, depending on the location of the demyelinating plaques, which could also potentially mimic a range of neurological and non-neurological disorders. We report a 24-year-old woman who presented with recurrent non-specific lower limb numbness, without any other neurological symptoms or signs. The symptoms were presumed to be nonspecific, but they re-occurred eight months later, leading to a more extensive investigation, including whole spine and brain MRI. The MRI showed multiple white matter lesions that are hyperintense on T2W/FLAIR, seen at the right corona radiata, bilateral parietal lobes, right periventricular region and spinal cord, with a simultaneous presence of gadolinium-enhancing and nonenhancing lesions, fulfilling 2017 Mc Donald’s diagnostic criteria for multiple sclerosis. After the careful exclusion of differential diagnoses, she was given pulsed IV methylprednisolone for 5 days, followed by oral teriflunomide. She improved partially, and at 2 months following discharge, she was tolerating the medication well with no further relapses.

Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is one of the fatal conditions that most commonly causes pregnancy-associated myocardial infarction. We herein report a case of P-SCAD in a 26-year-old multigravida woman, who complained of angina postpartum with raised cardiac biomarkers and transient ST-segment elevation on electrocardiograms. We emphasize the importance of a high degree of suspicion in the diagnosis of P-SCAD, together with the common presentation, the management approach, and its psychological impacts on the patients.

Introduction: Maintaining high levels of vaccinations is important for public health success in any vaccination planning. Success requires a better understanding of the public’s perceptions of diseases and consequent decisions about vaccinations. This study aims to gather exploratory qualitative data on public opinion on the Malaysian Government’s COVID-19 immunization campaigns. Methods: Open-ended question on Google Form was advertised online between 2 to 17 December 2020. The questionnaire form was deactivated when saturation has been reached. The free text questions were analysed by qualitative thematic analysis by all authors on a Microsoft Excel spreadsheet. Results: Six hundred and sixty-one participants replied to the online questionnaire. Four themes emerged from the thematic analysis on suggestions for future National COVID-19 Immunisation Program. First, COVID-19 vaccine administration policy; secondly, knowledge dissemination and plan to address obstacles of public acceptances towards the vaccine proactively; thirdly, better implementation programs by the government and fourthly, using local research expertise for vaccine development and alternative medicines. Participants believe all this are essential in increasing their trust and uptake for the government’s future national COVID-19 Immunisation Program. Conclusion: This study highlights the suggestions made by the public for the Malaysian Government. These findings will help develop education and intervention strategies for new vaccine introduction to combat the COVID-19 pandemic in Malaysia.

Introduction: Neuromodulation devices have emerged as an alternative treatment for drug-resistant epilepsy syndrome, especially for temporal lobe epilepsy (TLE). Transcranial direct current stimulation (tDCS) is one of neuromodulation techniques that shown promising results in refractory epilepsy. We aim to evaluate clinical efficacy of tDCS used in refractory TLE in clinical trial setting. Methods: Six-stages Arksey and O'Malley's methodology framework were used to guide this scoping review. PubMed, SCOPUS, and Cochrane Library were searched for clinical trials involving tDCS in refractory TLE. We also examined the tDCS protocol used, clinical efficacy and its side effects. Results: Five studies met the inclusion criteria. Three studies were randomized crossover studies, and the other two were randomized placebo-controlled double-blind study and pilot randomized control trial. A total of 85 subjects were involved with mean seizure frequency of 2.6 per week. TDCS protocols involved were 1 and 2 mA of direct current with varying frequency and duration. All studies showed improved seizure control in TDCS arm with minimal to zero side effects. Conclusion: TDCS appears as a safe and better option. Despite the benefit seen among refractory TLE, future prospective studies should focus on standardization of tDCS application as well as a more homogenous patient selection.

Vaccine hesitancy has been around since the introduction of smallpox vaccine. Vaccine hesitancy has become more intense due to the rise of vaccine information in social media and mass adult vaccination during COVID-19 pandemic. This study investigated knowledge, perception, and reasons for rejection of the COVID-19 vaccine among Malaysian adults who refused to get free COVID-19 vaccination.