MOH/S/CRC/65.20(BUL)-e CRC HKL E-NEWSLETTER

ISSUE 7, DECEMBER 2020

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Clinical Research Centre Hospital Kuala Lumpur (CRC HKL) Aras 3, Bangunan Pentadbiran dan Kewangan, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur Wilayah Persekutuan Kuala Lumpur.

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CONTENTS CLINICAL RESEARCH CENTRE HOSPITAL KUALA LUMPUR

Editor’s Note 3 HEAD OF UNIT DR. HJH SALINA ABDUL AZIZ

COVID-19, The Worst Pandemic in The DEPUTY HEAD OF UNIT 21st Century 5 DR KARINA KOH

Economy and Psychosocial Impact of EDITOR-IN-CHIEF COVID 19 6 DR NOOR HIDAYU WAHAB

EDITORIAL COMMITTEE Actions by The Malaysian Government DR NOR ALIYA AYUB to Combat COVID-19 8 DR PREM A/L W.P.VENUGOPAL DR NIK NUR ELIZA MOHAMED COVID-19 Vaccines: DR NUR AISYAH ABDUL RAHIM

Ethical Conundrum 11 HOSPITAL RESEARCH REVIEW COMMITTEE Impact Of COVID-19 on Clinical DR MOHD AZIZUDDIN Research: Challenges and Opportunities 14 AMIR SHARIFFUDDIN DR RAJ KUMAR A/L SEVALINGAM CIK SITI SALEHA ADNAN Zulu Team Hospital Kuala Lumpur:

Isopod (Isolation Pod) User CLINICAL RESEARCH OPERATION Training and Retrieval 17 DR LEE JEN VEN DR NUR AISYAH ABDUL RAHIM Mass Triaging and Retrieval of DR VARAALAKSHMY COVID-19 Patients 21 A/P GOKILAVANAN

RESEARCH QUALITY Role of Modified Snorkeling Mask DR NOOR HIDAYU WAHAB NIPPV Device In COVID-19 and DR NOR ALIYA AYUB SARI Patients 24 TRAINING & SKILLS DEVELOPMENT CRCHKL COVID-19 Journey 26 DR DURATUL’AIN MOHD NAZRI DR NADIAH ISMAIL DR PREM A/L W.P.VENUGOPAL Research Poster 30 PROMOTION AND COLLABORATION Publication by HKL Staff 2020 32 DR NIK NUR ELIZA MOHAMED DR SITI ZUBAIDAH OTHMAN

2020 Training Activities 46 ADMINISTRATIVE SISTER AZURA RAMLI Upcoming Courses in 2021 49 EN. MOHD HAFIZ EN. MOHD IKRAM ZAKI References List 51 PN. NURUL HAZWANI AIZAN EN. MULYADI RAMLI CRCHKL E-NEWSLETTER ISSUE 7 2020

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PAGE 4 CRCHKL E-NEWSLETTER ISSUE 7 2020 COVID-19 The Worst Pandemic in The 21st Century

By Dr. Nor Aliya Ayub, Dr. Prem A/L W.P. Venugopal Clinical Research Centre Hospital Kuala Lumpur.

In December 2019, number of cases recognized as zoonotic disease where an animal 19;Stage 1-asymptomatic, Stage2 - symptomatic of pneumonia caused by an unknown etiology virus undergoes mutations that permit it to in- and no pneumonia, Stage 3-symptomatic and had been observed in the city of Wuhan, subse- fect and replicate inside the human body where pneumonia, Stage 4-symptomatic, pneumonia quently spread across Asia and the world like it spreads rapidly through the human population and supplemental oxygen required, Stage 5- wildfire. On January 7, 2020, the Chinese au- (Elengue,.2020). The major modes of transmis- critically ill with multiorgan failure thorities identified a novel coronavirus (nCoV) sion are from the respiratory tract via droplets (Elengue,.2020). Severe infection and high as the cause of this severe pneumonia disease, and indirectly via fomites and to a lesser extent mortality are higher in older populations and and the identification of nCoV was confirmed via aerosols. possibly in those with preexisting clinical illness by the WHO on January 12, 2020 (Secon et al., For diagnosing COVID-19, early such as diabetes, hypertension, cardiovascular 2020; Wu YC et al,.2020). By the end of Janu- diagnoses were largely based on clinical, travel disease, and malignancies (Meckenzie and ary 2020, this disease was declared as a public and exposure history of a patient return from an Smith,.2020). health emergency of international concern and epidemic area and nonspecific laboratory find- Currently, there is no validated treat- subsequently declared as pandemic on the ings as specific tests were not yet available ment for COVID-19. The main strategies are th 11 of March 2020 by the WHO (Meckenzie during the first 3 to 4 weeks of the outbreak. symptomatic and supportive care. However, and Smith,.2020). The pathogen of the outbreak Detection of the virus has been based on detec- there are numbers of therapeutics under investi- was identified as a novel beta-coronavirus, tion of the viral RNA by PCR, with various gation with some undergoing clinical trials in named 2019 novel coronavirus (2019-nCoV) assays directed particularly at the envelope (E), China and elsewhere. Early interest focussed on and this virus remind us the terrible memory of RdRp, spike protein (S), and nucleocapsid (N) the HIV protease inhibitor combination lop- the severe acute respiratory syndrome (SARS) genes (Meckenzie and Smith,.2020). COVID-19 inavir/ritonavir, a new broad-spectrum antiviral in 2003 and Middle East Respiratory Syndrome symptoms are manifest usually as fever, dry agent called remdesivir, which has shown prom- (MERS) in 2012 caused by another beta- cough and tiredness. These symptoms appear ising activity against MERS-CoV in animal coronavirus (Wu YC et al,.2020; Shah et similar to common influenza, but the spread is models, and possibly chloroquine. Combina- al,.2020). way far speedier. Despite its low fatality as tions of these with interferon-β and/or ribavirin The novel Coronavirus (nCoV) is an compared with SARS, its high infectibility has are being trialled, while other groups are look- enveloped, positive single-strand RNA virus. It led to a contagion of fear worldwide (Umair S et ing at a range of other antivirals, convalescent belongs to the orthocoronavirinae subfamily, as al,.2020). The commonest clinical features are plasma, and monoclonal antibodies (Meckenzie the name, with the characteristic “crown-like” fever with a respiratory illness, several studies and Smith,.2020). spikes on their surfaces (Wu YC et al,.2020; have reported fever in 80% to 99% of cases, dry The pandemic may seem to have Shah et al,.2020). This virus falls under genus cough in 48% to 76% of cases, fatigue or myal- gone on forever. As we approach the end of beta-coronavirus. The genus beta-coronavirus gia in 44% to 70% of cases, and dyspnea in 30% 2020, it is easy to lose sight of how much pro- can be divided into several subgroups; nCoV, to 55% of cases (Meckenzie and Smith,.2020). gress science has made over the past 1 year. SARS-CoV, and bat SARS-like CoV belong to Apart from that, some infected individuals may Since January, scientist have gained a far Sarbecovirus, while the MERS-CoV belongs to have mild symptoms like headaches, muscle better understanding of COVID-19, and have Merbecovirus. Several studies have strongly pains, runny nose, sore throat or diarrhea while develop vaccines to battle the infections. This suggested that bats were the main host of this some patients may suffer from severe pneumo- COVID-19 vaccine development seems the only coronavirus, as the whole genome-wide nucleo- nia, organ failure, acute respiratory tract infec- hope that human being can rely on. The promis- tide sequences of the nCoV were 96% identical tion and septic shock, which can lead to death. ing vaccines, better testing and treatment and to bat coronavirus (Shah et al,.2020). Consump- However, there are some infected people with- also greater knowledge we now have hopefully tion of infected, raw or semi-cooked meat can out any symptoms which is called asymptomatic can control the pandemic far better by early of lead to the transmission of the virus. COVID-19 carriers. There are 5 clinical stages of COVID- 2021.

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ECONOMY AND PSYCHOSOCIAL IMPACT OF COVID-19

By Dr. Noor Hidayu Wahab Clinical Research Centre Hospital Kuala Lumpur

To slow the spread of COVID-19, many of these excepting those related to essen- (VM2020) campaign that aimed to attract 30 most countries in the world have implemented tial amenities, are closed for a long duration of million tourist arrivals has also been cancelled regulations that require social distancing, the time. Production level has gone very low. People due to COVID-19 crisis. Malaysian government closing of non-essential businesses, travel re- belonging to the tourism are also facing utmost estimated the VM2020 campaign to attract 30 strictions and, in many cases, stay-at-home or- difficulties. Economy of many so-called power- million tourists and revenues up to RM 100 ders. Human interactions that drive the econo- ful countries are now facing the threat of high billion. However, with COVID-19 arises, it my, such as working together in enclosed areas inflation and increasing unemployment as a obviously has decreased the number of visitors and enjoying entertainment activities, have been result of lack of productivity and excessive ex- and revenue for the whole year of 2020. discouraged, restricted, or banned altogether penditure for the treatment and rehabilitation of (Shakeel S, 2020). (Fitzgerald D.A., 2020). Although these the COVID-19 victims and their families As the COVID-19 pandemic drags on measures are necessary for public health, recent (OECD Interim Economic Assessment, 2 March globally, there is little doubt that it is taking a evidence suggests that COVID-19 has severely 2020). lasting toll on the physical and mental health of demobilized the global economy. It has been In Malaysia, the massive and ongoing almost all people. The price of isolation and a estimated that since World War II, the average outbreaks of this virus have become a serious sense of societal obligation to assist may inad- economic recession results in an increase in threat with profound consequences for the econ- vertently include reluctance to bring the unwell unemployment of around 2% (Fernandes N., omy and financial markets as a whole. The fi- for medical assessment where the risks of medi- 2020). Some of the experts are even saying that nancial market is predicted to collapse, with the cal review in the community or hospital can be human civilization has not faced such an unprec- chance of a new global recession (Majid, over-emphasised leading to late diagnoses with edented emergency after the World War-II M.,2020). The sudden enforcement of the MCO very unwell people (Lazzerini M,2020). The (Chakraborty I, Maity P, 2020). Lockdown due by the government put various sectors of the much-heralded substitute for face to face clinical to COVID-19, directly affect the Gross Domes- economy in jeopardy. According to AmBank consultations has been the use of web-based tic Product (GDP) of each country in the major Group chief economist Anthony Dass, direct platforms or telephone consultations, but whilst economics. According to World Trade Organiza- damage caused by the virus can be seen in the helpful for routine follow-up consultations, they tion (WTO) and Organization for Economic tourism and travel industries, manufacturing, do have significant limitations for new or chal- Cooperation and Development (OECD) have construction, mining, and agriculture, with many lenging diagnostic cases as they lack the ability indicated COVID-19 pandemic as the largest workers being laid off and others being placed for physical examination. Moreover, the ability threat to global economy since the financial on unpaid leave (Murugiah, 2020). The forced to readily access routine investigations has also emergency of 2008–2009. closure of businesses, mainly the small and been lost with the concerns about infection risk, Many of the affected countries have medium sized enterprises (SMEs) and services, albeit mainly extrapolated from valid concerns decided to undergo complete lock down in order could probably lead to permanent shutdowns and in the care of adults and children (Fitzgerald to restrict further transmission of the disease in many losing their jobs, as well as individuals D.A., 2020). the community. Major international flights and going bankrupt (Cheng, 2020). The Prime Min- also all types of business transports have been ister of Malaysia Tan Seri Muhyiddin Yassin has deferred amid different countries. In almost all particularly stated that the nation's tourism in- the COVID-19 stricken countries, entire educa- dustry has been crippled, with an estimated loss tional, commercial, sports and spiritual institu- of RM 3.37 billion in the first 2 months of the tions are closed. Industries are suffering a lot as year (Dzulkifly, 2020). The Visit Malaysia 2020

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Psychological consequences caused the present day. But, due to the unusual outbreak by COVID-19 pandemic are enormous. In May of COVID-19, almost every big and small cities 2020, the United Nations Secretary General and villages in the affected countries, are under issued a message that the COVID-19 pandemic partial of total lockdown for a long period of had resulted in massive mental suffering and time ranging from a few weeks up to a few called for actions. Distress, anxiety, depression, months. Due to non-functioning of industries, and insomnia are relevant mental health disor- industrial waste emission has decreased to a ders due to their prevalence during COVID-19 large extent. Vehicles are hardly found on the outbreaks (Kang L, 2020). Lockdowns or quar- roads resulting almost zero emission of green- antines are hostile experiences that can cause house gases and toxic tiny suspended particles to severe financial stress due to loss of employ- the environment. Due to lesser demand of power ment; social disorders such as social withdrawal, in industries, use of fossil fuels or conventional cyberbullying, alcohol misuse, and addiction energy sources have been lowered considerably. and mental health issues such as suicide Ecosystems are being greatly recovered. Ozone attempts and depression (Reger, M.A., 2020). layer has been found to have revived to some People those in quarantine experience monoto- extent. The pandemic has displayed its ny, aloneness, irritation, worsening anxiety, and contrasting consequence on human civilization, mental distress. COVID-19 has been repetitively in the sense that, on one hand it has executed labelled as a killer virus, mainly on social me- worldwide destruction, but created a very dia, which has prolonged feelings of perceived relapses, owing to fear, anxiety and social positive impact on the world environment on the threats and uncertainty. rhythm disruption. Furthermore, social other hand (Chakrabortya, I, 2020). Fear and anxiety towards COVID-19 distancing forces an individual to stay at home could potentially be overwhelming and hence for an extensive period. If the individual is heighten the mental stress towards oneself and already living in a pre-existing toxic home society. This fear and anxiety are compounded environment, spending more time at home could by social distancing as individuals want the best be extremely stressful. The Women’s Aid of both worlds which is to be connected, yet to Organisation and Talian Kasih reported an not contract the ongoing coronavirus infection. increment of 44% and 57% respectively in However, social distancing could disrupt the contacts after the government-issued Movement social rhythm, by depriving one's regular coping Control Order (MCO), for which domestic abuse mechanisms with stress – hence putting mental is one of the reasons cited (Lee, H.,2020). health at stake. According to the American Besides the general population, health Psychiatric Association (APA), about 62% of care workers on the front line are also at risk of Americans are suffering from symptoms of developing psychological distress while anxiety, which is related to COVID-19 and 59% managing patients with COVID-19. The long feels that the virus is greatly impacting their day working hours under uncomfortable and stress- -to-day lives (Canady, V.A.). ful conditions may jeopardize their psychologi- Losing job in many people as an cal well-beings as well as their morale and work economic consequence of COVID-19 brings in performance (Waleed et al., 2020). Apart from feelings of uncertainty and insecurity - which the social pressures faced at home and in the eventually disrupts mental health, leading to society due to the implementation of MCO, feelings of anxiety and depression. The financial these critical frontliners are also at high risks of burden hitting the population in Malaysia could to be exposed to serious mental health issues further escalate with individuals coping by resulted in symptoms such as being stressful, drinking alcohol and taking illicit substances severe depression, decline of work motivation, which then give further rise to multiple other fatigueness, and over-anxiety (Jianbo et al., disorders such as alcohol use disorder and so on 2020) (Hemavathi, S, 2020). Pandemics may also Despite of all the negative impact negatively impact the poor and vulnerable towards human lives, COVID-19 pandemic populations, and especially patients with serious gives outstanding environmental effect. As an mental illness (Druss, B.G.). People with pre- inevitable consequence of global warming, existing mental illnesses suffer a greater risk of environment pollution has become a big issue of

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ACTIONS BY THE MALAYSIAN GOVERNMENT TO COMBAT COVID-19

By Dr. Nor Aliya Ayub Clinical Research Centre Hospital Kuala Lumpur

Malaysia's recent success in control- Ministry of Health has implemented public most of the cases mainly concentrated from ling the spread of COVID-19 has been acknowl- health interventional strategies. A rapid reverse Kedah and Sabah. The Malaysian Government edged by the WHO and it is closely related to transcriptase-PCR test on patients and relations has implemented Enhanced Movement Control immediate and proactive action taken by the was developed, used and provided to other gov- Order (EMCO) on the areas with a high number Ministry of Health (MOH) including enforce- ernment hospitals and medical laboratories, and of COVID-19 cases; Targeted Enhanced ment of the different phases of Movement Con- management guideline were developed (Umair Movement Control Order (TEMCO) to a much trol Order (MCO); alliance with various organi- S et al., 2020). Specific hospitals were then smaller space with a high number of COVID-19 sations, including non-governmental organiza- identified and assigned to handle COVID-19 cases, such as a residential complex or an office tions (NGO) to host fundraising as well as cases as a measure to isolate the patients and building; and Administrative enhanced move- providing personal protective equipment for prevent them from affecting others. Subsequent- ment control order (AEMCO) applies similarly frontlines (Minhat and Shahar K., 2020). ly, other ministries such as Ministry of Educa- to specific high-risk areas but with fewer Similar to the high-income nations, tion (MoE), Ministry of Defence (MinDef) and restrictions (Flanders Trade, 2020). low and middle-income countries (LMICs) also private hospitals collaborate to accommodate For community-based control responded to COVID-19 by implementing vari- the growing number of COVID-19 cases. As of measures, outdoor limits were also ous public health interventions at population- 31 October 2020, there are 46 designated hospi- implemented, whereby only one resident from a level, including strict nationwide lockdowns and tal in Malaysia to handle and manage COVID- physical distancing. These interventions have 19 case and there are 118 screening centres for generally been successful in preventing over- COVID-19 (Garis Panduan Pengurusan COVID loading of health systems, particularly in LMICs 19 di Malaysia No.5., 2020). where the risk of disease transmission is high To effectively control the current due to high density of communities and interac- COVID-19 situation, the Malaysian Govern- tions; inadequate knowledge of disease preven- ment has implemented different levels of tion; under-resourced of public health systems; Movement Control Order (MCO) in the areas restricted access to healthcare facilities, espe- with the presence of COVID-19 cases, depend- cially rural areas; and relying on mostly out-of- ing on the number of active cases in the area. pocket payment (Chowdhury et al., 2020). Initially, the government imposed a 2-week family was permitted to leave at one time and Among the earliest actions taken by MCO starting from 18 to 31 March, which was within 10 km of the house. Checkpoints were the MOH to prevent this virus transmission is extended to 14th April, then to 28th April until set up to track temperatures at the access point by enforcing health screening at all points of 3rd May. As the curve flatten, the government of homes, pharmacies and grocery stores. For entry, placing thermal scanners to enhance fever imposed Conditional Movement Control Order better prevention, Malaysian citizens were detection among tourists and/or local returning (CMCO) from 4th till 9th June 2020 then banned from leaving the country, and foreigners from abroad. People arriving from countries Recovery Movement Control Order (RMCO) were also not permitted to enter the country. with high cases of COVID-19 have been from 10th June till 31th August 2020 (Flanders screened, identified and quarantined in separate Trade, 2020). On October 9, 2020, Malaysia quarantine areas. These precautions have also Health director-general Tan Sri Dr Noor been extended to airline crews as well as to Hisham Abdullah states that Malaysia entering MOH staffs (Shah A et al., 2020). Initially, the its third wave of COVID-19 (Bernama, 2020),

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'Resolving, resilience, restarting, recovering, revitalizing and preparation and disposal. They also provide training to the Royal Malay- reforming' is a new norm for the citizens of Malaysia. The Malaysian sian Police (PDRM) on proper hand hygiene and washing, donning and Government's six-step strategy is to resolve the effects of COVID-19 and doffing of the standard full personal protection equipment (PPE). A to ensure that the country emerges stronger despite this outbreak. Using severe pandemic is the incident most likely to create a need for an exces- this six-step strategy, Malaysians are seeking to adhere with new rules of sive death number contingency planning. A COVID-19 Centralized operating procedures (SOPs) to avoid another wave of infections in the Body Facility is a temporary mortuary centre for all COVID-19 deaths country and to revive the economy in stages (The Straits Time, 2020). within a country. This centre adopting the concept of a quarantine centre

In terms of public awareness and acceptability of this pandem- to locate COVID-19 patients if their numbers become overwhelming, ic, the Ministry of Health always be transparent in handling the pandem- there is a need to relocate the remains of all decedents who were infected ic by providing sufficient and up-to-date information to the public with COVID-19 to a temporary mortuary centre when mortuaries are through various platforms including the Official MoH website, social overloaded (Khoo L,. 2020). media such as facebook and telegram; called Crisis Preparedness and To help Malaysian who are financially affected by COVID-19, Response Centre (CRPC) page, Kementerian Kesihatan Malaysia the government introduced an emergency stimulus package, one of the (KKM) page, and CRPC KKM Telegram. MOH also provide communi- largest in the world, to stabilize economic development, promote invest- ty education and awareness programmes regarding COVID-19 in a sim- ment and foster business activity (Umair S et al., 2020). The PRIHATIN ple diagram and infographic via website and social media to reach public Package has been one of the beneficial initiatives announced by the gov- easily. They also conducted daily press conference or recordings and has ernment, followed by drastic measures of a 6-month moratorium offered published related news on COVID-19 to increase public engagement and by Bank Negara Malaysia to reduce the financial impact. Credit card- ensure public awareness and access to reliable information (Shah A et holders can choose to convert outstanding balances into term-loans. The al., 2020). Besides that, the media also plays an important role in active- corporate sector can restructure their bank loans. Other than that, Minis- ly spread the information and boost up the frontliner’s spirit in handling try of Heath also setting up the special fund known as COVID-19 fund, and managing this outbreak. Hashtag #stayhome, #kitajagakita are fre- to help for those particularly financially affected due to quarantine pro- quently appeared in radios and television (Minhat and Shahar K., 2020). cess. Through this fund, RM 100 was given daily to who had no source Non-governmental organizations, as well as prison inmates, started to of income throughout the quarantine and treatment processes, this fund also used to cover medical expenses such as buying crucial equipment and other supplies (Shah A et al., 2020). IRB also offering tax deduc- tions for cash and item donations to help the affected communities.

In terms of mental health support, Ministry of Health, Malay- sia has provide guideline about Mental Health and Psychosocial Support in COVID-19 in Annex 33 (Garis Panduan Pengurusan COVID 19 di Malaysia No.5 b, 2020). Mental Health and Psychosocial Support (MHPSS) refers to any type of local or outside support that aims to pro- tect or promote psychosocial well-being or prevent or treat mental disor- ders. This support may be provide to all public that affected especially Healthcare workers (HCW), person under supervision (PUS) as they are worry of possibility that their family members are infected. Support may include interventions in health, education, or interventions that are com- produce personal protective equipment for frontliners. Various organiza- munity-based. tions hosted fundraising events to provide essentials mainly to hospitals (Shah A et al., 2020).

As at October 31, 2020, there have been 1,182,747 deaths around the world (WHO, 2020) and the numbers keep growing without no proven definite treatment or vaccine for this disease. Hence, National Institute of Forensic Medicine (IPFN) Malaysia has produced a guideline on management of the dead for all COVID-19 suspected or confirmed deaths within the hospital as well as from outside the hospital. This guideline consists of various sections including guidelines on body transport from Emergency Departments or wards to the mortuary, post- mortem examination, handling of the body and religious/ritual body

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COVID–19 VACCINES : ETHICAL CONUNDRUM

By Dr. Nik Nur Eliza Mohamed Clinical Research Centre Hospital Kuala Lumpur

At present, there are several clinical ceive the trial vaccine. In phase two, the num- provision on information, volunteer compre- trials being conducted to identify the safest and ber of study volunteers are expanded and the hension on the clinical trial process involved the most effective vaccine for COVID-19. In trial vaccine is given to a diverse group of and voluntariness from the study volunteer. November 2020, COVID-19 vaccine developed volunteers. During the phase three, it would be Hence, these three elements must be present to by Pfizer and BioNTech had reported prelimi- a large-scale study with the main objective to validate the autonomy of the study volunteers. nary data in offering 90% protection against confirm the effectiveness, to establish the trial Firstly, essential and relevant information per- COVID-19. In addition, a United State based vaccine safety profile and to compare it with taining to the study must be conveyed to the company, Moderna has also announced that its the placebo or a comparative vaccine product. volunteers adequately. Some of the important vaccine candidate is capable to offer 94.5% At present, without the proven effec- information include the study objectives, the protection against COVID-19. These two vac- tive treatment against the infection, the devel- anticipated risks and benefits, the study proce- cines are reported as mRNA vaccines which opment of COVID-19 vaccine had been the dures and the details on the trial drug. Second- would be required to be stored at -70 and -20 utmost priority in combating the pandemic ly, the methods and the context on how the Celsius. (British Broadcasting Corporation, which had affecting billions of lives world- information is conveyed to the study volunteers 2020.) Other promising vaccines include the wide. With the urgency and the dire needs of must be in organised and professional manner. vaccine being developed by British pharmaceu- the vaccine, the development of COVID-19 The study volunteers must be allowed the op- tical company AstraZeneca in collaboration vaccine had been relatively much shorter as portunity to inquire for clarification to enhance with the University of Oxford and Sputnik compared to other vaccines which usually take their understanding on the study involved. vaccine which being developed in Russia. years to be developed. However, there are a Lastly, the study volunteers must be able to

By definition, a vaccine is a biologi- number of ethical considerations pertaining to participate in the study voluntarily without any cal preparation that provides active acquired the COVID-19 vaccine development. The ethi- form of coercion or undue influence. However, immunity to a particular infectious disease. cal principles on COVID-19 vaccine develop- inducement might be considered as undue in- (IACT Health, 2020) The development of any ment could be discussed based on the four main fluence if the study subjects are vulnerable in vaccine must undergo a series of standardized principles of biomedical ethics introduced by terms of socio-economic status or under the clinical development. In general, the develop- Beauchamp and Childress namely autonomy, higher authority such as being a prisoner. ment cycle of a vaccine includes the explorato- beneficence, non-maleficence and justice. ry stage, the pre-clinical stage, the clinical The study volunteers who had development, the regulatory review and ap- agreed to participate in the COVID-19 vaccine proval, manufacturing and quality control. clinical trials must do so in their own freewill. (Centres for Disease Control and Prevention, Informed consent is a key process in ensuring 2020) The clinical development is a three- the autonomy of each study volunteer is re- phase process. During the phase one study, a spected. A legally and ethically acceptable small group of healthy volunteers would re- informed consent must consist of adequate

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The essentiality of the vaccine is non nocere”. In the context of clinical regarding the adverse events which poten- one of the main considerations of the ethi- trials, it would be almost impossible for tially harm the study volunteers. cal principle of beneficence. The urgency any clinical trials to be conducted without In any clinical trial, the benefits and the necessity of the vaccine is mainly any risks or harm to the study volunteers. to the society and the study volunteers to reduce the associated morbidity and The ‘harm’ subjected to the human volun- should outweigh the risks to the volun- mortality of the COVID-19. To date, more teers might be directly or indirectly caused teers. The risk stratification and assess- than 1.4 million death with over 61 mil- by their participation in the clinical trials. ment should be conducted by independent lion COVID-19 cases had been reported However, the risks or harm in any clinical bodies such as the ethical committees to worldwide. Malaysia is being hit with the trials must be minimised to protect the prevent the element of biasness. Risk local third wave of COVID-19 pandemic safety and well-being of the study volun- minimization and mitigation plan should with the total over 60,000 reported cases teers. In the case of a vaccine study, the be in place to reduce the harm towards the with more than 300 COVID-19 mortalities ‘harm’ is possibly caused with the healthy volunteers. If there is any imminent health recorded to date. (Wordometers, 2020) In volunteers being deliberately exposed and hazard such as worsening health condition addition, travel restrictions and disrup- infected with the pathogens. In a human of the volunteers, the volunteer should be tions in terms of economic, education, vaccine challenge study, it involves the withdrawn from participating further in healthcare access, mental health are some intentional infection of research partici- the study. Another ethical consideration of the devastating effects from the pan- pants and can accelerate or improve vac- which must not be overlooked among the demic. Thus, the argument for essentiality cine development by rapidly providing altruistic volunteers who sign up for po- of the COVID-19 vaccine is very much estimates of vaccine safety and efficacy. tential challenge studies amidst the global supported with the quantum of disruption (Eyal et al, 2020) This might raise an COVID-19 pandemic is that they may also and destruction caused by COVID-19 ethical concern on the potential devastat- suffer from misconception and overconfi- throughout the whole world. In addition, ing adverse event on the volunteers who dence that the research will provide sub- the sense of safety and reassurance espe- participate in the clinical trial. This is stantial future societal benefit. (Dawson et cially among the high-risk communities compounded with the fact that COVID-19 al, 2020) This is substantiated with the would be restored to pre-pandemic with infection has no proven clinical treatment fact that there is always an element of the availability of the vaccine. For person- so far which potentially might lead to uncertainty or failure amidst the journey al or individual reasons, many study vol- morbidity and mortality of the volunteers. towards the vaccine development. unteers would cite the reason being altru- (Jamrozik and Selgelid; 2020) The recent ism for their motivation to be one of the example of the reported death of a volun- COVID-19 study volunteers. teer in a clinical trial of the COVID-19 Non-maleficence can be trans- vaccine developed by AstraZeneca and lated to “do no harm” as it is closely asso- Oxford University had been a public inter- ciate to the Latin phrase “maxim primum est and had raised some ethical concerns

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The final ethics principle evolv- What are the roles of the re- ing around the development of the COVID- searchers? They are tasked to conduct the 19 vaccine is ‘Justice’. Two essential ele- clinical trials as according to the Good ments under ‘Justice’ would be non- Clinical Practice. In addition, they must exploitation and relevance to the communi- ensure that the study volunteers are protect- ty. For non-exploitation, the protection of ed, data integrity is preserved and clinical the rights, safety and welfare especially trial is conducted as according to the ap- among vulnerable human subjects such as proved protocol. This is clear stated in prisoners, those who are with lower socio- Good Clinical Practice clause 4.8.1 which economic status and persons with disabil- states ‘’In obtaining and documenting in- ity. In terms of the relevance to the commu- formed consent, the investigator should nity, local societal benefit of the vaccine comply with the applicable regulatory re- especially when the study volunteers were quirement(s), and should adhere to GCP derived from the community must be taken and to the ethical principles that have their into consideration. For example, the Afri- origin in the Declaration of Helsin- can continent which is generally consist of ki.” (Malaysia Guideline for Good Clinical some of the low- and middle-income coun- Practice, 2018) tries is statistically least affected by In conclusion, clinical trial is an COVID-19 as compared to other part of the essential process in the advancement of world. Thus, the decision to conduct any science. The ethics considerations based on COVID-19 related clinical trial among the the four major ethical principles as dis- local community must be carefully consid- cussed early could serve as an important ered. ethics framework in designing, monitoring The ethics committee functions as and conducting clinical trial related to independent body in which is authorized to COVID-19. In the pursuit of vaccine crea- regulate and to monitor the conduct of any tion and development, the safety and well- clinical trials locally. The committee would being of the study volunteers must not be be responsible to do so by upholding the compromised. Referring to the ICH GCP requirements based on the Good Clinical clause 2.3 which has clearly stated that Practice. The main objective would be to “The rights, safety, and well-being of the ensure vigorous scrutiny prior to the vac- trial subjects are the most important con- cine study approval to protect the safety siderations and should prevail over inter- and well-being of the human volunteers ests of science and society.” (Malaysia and future recipients of the vaccine. The Guideline for Good Clinical Practice, 2018) relevant clause in Good Clinical Practice is In another words, the volunteers must never stated in clause 3.1.1; An IRB/IEC should be sacrificed in the pursuit of any scientific safeguard the rights, safety, and well-being advancement. Nonetheless, when risks or of all trial subjects.” (Malaysia Guideline harm is almost to be fully avoided or eradi- for Good Clinical Practice, 2018) An up-to- cated, measures must be taken to optimally date publication by World Health Organisa- safeguarding the volunteers’ rights, safety, tion entitled ‘Key criteria for the ethical and well-being. acceptability of COVID-19 human chal- lenge studies’ would be an excellent refer- ence for the local ethics committee to eval- uate any local clinical trials for the -19 vaccine studies.

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IMPACT OF COVID-19 ON CLINICAL RESEARCH : CHALLENGES AND OPPORTUNITIES

By Dr. Nur Aisyah Abdul Rahim Clinical Research Centre Hospital Kuala Lumpur

The recent global public health cri- curb the spread of the COVID-19 infection. sponsors to determine that the participant’s sis, COVID-19 pandemic, has undoubtedly The MCO is imposed under the Prevention and safety, welfare, and rights is best served by created a massive threat on health system and Control of Infectious Diseases Act 1988 and continuing the trial as per protocol or by dis- healthcare delivery worldwide. Clinical re- well as the Police Act 1967 (MKN, 2020). The continuing the administration of investigation- search practice is no exception, with the un- above-mentioned challenges may lead to diffi- al product or even participation in the trial precedented situation causing tremendous culties in meeting protocol-specified proce- (FDA guidance, 2020). Aside from this, 3 disruptions on both new and ongoing clinical dures especially for administering the investi- studies had to postpone their subject visits in trials (EMA guidance, 2020). This is particu- gational product or adhering to protocol- view of travel restrictions and 1 study due to larly relevant for clinical research not directly mandated visits and laboratory/diagnostic test- trial subjects’ unwillingness to visit hospital involved with COVID-19 management, and ing (FDA guidance, 2020). Therefore, taking site during the MCO period which resulted in those requiring participants’ access to clinical this into account, both of the Malaysian regula- an anticipated protocol deviation. Among all sites. tory body and ethics committee namely, the of the ISR studies, 3 study protocols were National Pharmaceutical Regulatory Agency amended to allow the conversion of physical Various organisations, agencies, and (NPRA) and the Medical Research Ethics visits into phone call assessments. In addition, authorities worldwide have recognised the Committee (MREC), respectively, recognised 1 study decided to deliver the investigational impact of COVID-19 pandemic on the conduct that protocol modifications and unavoidable medicinal products (IMP) directly to trial par- of clinical trial hence, issued guidance for protocol deviations may be required. ticipants’ homes during the COVID-19 pan- industry, investigators, and institutional review demic. These changes were implemented to boards on how to manage clinical trials during In Hospital Kuala Lumpur (HKL), minimise risk of spreading or acquiring infec- the pandemic while protecting the safety of there is a total of 60 ongoing industry- tion by preventing avoidable visits to study patients and healthcare workers. The key au- sponsored research (ISR) studies that are coor- site. Similarly, majority of the Clinical Re- thorities include the European Medicines dinated together with Clinical Research Ma- search Associate (CRA) visits for source data Agency (EMA), the U.S. Food and Drug Ad- laysia (CRM). During the MCO period from verification (SVD) were either postponed or ministration (FDA) and United Kingdom’s March until June 2020, most of the ISR studies conducted as remote monitoring via video calls Medicines and Healthcare Products Regulatory were able to proceed with minimal disruptions, only when necessary. All of the changes men- Agency (MHRA). especially for oncology studies because conti- nuity of treatment is crucial for patient safety tioned above are in line with the EMA and Some of the main challenges in con- as it is either part of the standard of care or FDA guidance. Evidently, the disruptions ducting clinical research during this pandemic trial protocol. However, there were 4 studies in caused by COVID-19 has pushed stakeholders may arise from quarantines, site closures, hos- recruitment phase that the sponsors decided to toward remote monitoring technologies and pital restrictions, travel restrictions, interrup- withhold in order to protect the safety of trial telehealth to make trials more patient-centric tions to the supply chain for the investigational subject and site personnel by minimising risk while maintaining trial integrity. product and safety concern of trial participants of exposure to the COVID-19 infection. The and site personnel (FDA guidance, 2020). This decision to continue or discontinue a study is particularly the case when the Malaysian should be made in accordance with the FDA government enforced a nationwide Movement guidance, which called upon researchers and Control Order (MCO) on 18th March 2020 to

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“In March 2020, WHO launched the world’s largest randomised control trial on COVID-19 therapeutics called the Solidarity Trial. This shows that large international trials are possible, even during this challenging time”

As for investigator-initiated research (IIR) studies, there terim results from this trial indicated that none of the treatment are a total of 207 studies registered under Clinical Research Centre regimens had significant effect on mortality and in-hospital course (CRC) HKL in 2020 compared to 259 studies in 2019, which is a among COVID-19 patients (WHO Solidarity Trial, 2020), the pro- 20% reduction. However, out of the 207 studies, 42 are COVID19- gress achieved by the Solidarity Trial shows that large internation- related studies. The decline in the number of non-COVID19 IIR al trials are possible, even during this challenging time. studies may be attributed to the need for hospitals to prioritise clin- Another major impact that COVID-19 has on our research ical activities in managing patients and staff affected by the pan- community is its influence on scientific meetings and conferences. demic (Lorusso, D. et al., 2020). For example, many HKL staff Undoubtedly, many research conferences have been cancelled or from various departments were deployed to help the emergency postponed on an unparalleled scale (Lorusso, D. et al., 2020) in department, coronavirus mass screening area (CMSA), COVID-19 order to comply to the standard operating procedure (SOP) espe- wards, quarantine centres and COVID-19 operational room. Con- cially during the MCO period. For example, the 13th National Con- sequently, many investigators were pulled away from working on ference for Clinical Research (NCCR), cleverly titled “Conference clinical research to work in emergency medical care where the of Very Important Disease (COVID)”, was conducted virtually for pandemic threatened to overwhelm critical care resources (Van the very first time including virtual viewing of scientific posters Dorn, A., 2020). Undeniably, this pandemic has sparked great in- submitted for evaluation. Similarly, training workshops and week- terest in the disease, not only in HKL but also worldwide as evi- ly Hospital Research and Review Committee (HRRC) board meet- denced by the 2995 COVID19-related clinical trials registered with ings organised by CRC HKL were also done virtually whereas the ClinicalTrials.gov (Van Dorn, A., 2020). The EMA guidance rec- research consultation clinic (RCC) sessions were done either via ognises that the authorities should give priority to any (new) clini- emails or phone call consultations. Although this pandemic has cal trial application for the treatment or prevention of COVID-19 caused tremendous disruptions to many of our previously planned infection (EMA guidance, 2020). Therefore, it is fitting that scientific meetings, it has also created an opportunity to explore MREC has offered an expedited ethical review and approval for new methods of communicating and organising events using vari- any relevant COVID19-related studies to help increase the ous underutilised virtual platforms and online interactive tools. knowledge in this research area. It is unquestionable that the COVID-19 pandemic has With the global pandemic affecting more than 180 coun- imposed many challenges in the conduct of clinical research. tries, efforts have been made to find possible life-saving treatment Therefore, it is the responsibility of all stakeholders involved to to fight against this severe acute respiratory syndrome coronavirus work together to continue their efforts in protecting the safety of 2 (SARS-CoV-2) infection. In March 2020, WHO launched the trial participants and site personnel, maintaining compliance with world’s largest randomised control trial on COVID-19 therapeutics good clinical practice (GCP), and minimising risks to trial integri- called the Solidarity Trial. This international trial enrolled almost ty. With this notion in mind, all parties should strive to continue 12,000 patients in 500 hospital sites in over 30 countries, including conducting high-quality clinical research even during this unprece- Malaysia, with HKL being one of the nine Ministry of Health dented era. (MOH) hospitals involved (WHO News, 2020). Although the in- PAGE 15 CRCHKL E-NEWSLETTER ISSUE 7 2020

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ZULU TEAM HOSPITAL KUALA LUMPUR: ISOPOD (ISOLATION POD) USER TRAINING AND RETRIEVAL

Dr Amira Farhana Abdul Khalil Emergency and Trauma Department, Hospital Kuala Lumpur, Malaysia

ing include mini lecture followed by a simula- Introduction Section 1: Isopod User Training tion-based training, visualisation and coopera- The COVID-19 pandemic has taken Isopod is a portable device that tive learning. Teamwork is very important to stage worldwide since it’s detection in Wu- provides a negative pressure environment and guarantee successful and safe patient han, China in November 2019. It has taken is used during the transportation of highly transport. over the world in such a rapid pace, far more infectious patients, namely COVID-191. It Isopod simulation training encom- threatening than expected, causing countries requires a specialised team that understands passes the important aspects of airway man- to play ‘catch up’ to it; from preparedness, the use of it and able to troubleshoot problems agement during mobilisation from one ward to detection, and treatment in order to curb the within its environment once it is sealed2. User another; in the same hospital or inter- rising number of cases. It has been putting training is very essential for the safety of the hospitals. Training includes clamp/ massive burden on governments, healthcare patient, healthcare providers, and general unclamping of endotracheal tube (ETT), pre- workers and facilities at all levels. Infection public. We teach the principles of transporting paring and setting the ventilators (e.g not to rate and fatalities were and is going up by the a ventilated patient with COVID-19 which is, ventilate during standby mode). This is ex- minute, including the frontliner themselves. to prevent aerosolisation and minimising tremely crucial in order to prevent aeresolisa- Hospitals ran out of resources quickly thus, spread at all times. We have a prepared check- tion to transport staff and surroundings. the most efficient way is to work together and list for Isopod transportation to ensure that Breathing and circulation are managed by use all sources in well-ordered manner. Re- complications can be prevented and managed allied health personnel whereby the monitors education in infection control, safety proto- more efficiently during the highly stressful and oxygen tank are placed in such a way that cols, equipment handling were implemented period. it will not disrupt the lean process during to enhance treatment, ensure safety of all per- The training was originally lead by transportation. Infection control (donning and sonnel and cater of those performing floor Dr Umul Khair Mohamad who subspecialised doffing) are also integrated to prevent decon- managerial work. These are also essential to in Pre-Hospital Care & Disaster and was ech- tamination. Apart from that, all members were curb infection from spreading. In the Hospital oed to others with similar interest. Up to date, also being taught to debrief and perform post Kuala Lumpur, we are proud that simulation- we had a total number of fifteen trainings that mortem after each transfer is done. based training done for COVID-19, is at par were held since the pandemic started. We had with other countries overseas. already trained 43 doctors (twelve Emergency Physicians and 31 Medical Officers) and 39 allied health personnel. Methodology of teach-

Figure 1: A short lecture was given as an introduction before the hands-on session

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Figure 2: The importance of managing the airway by the team leader is shown above as example (during static and dynamic movement)

Figure 3: We demonstrated a proper placement of the isopod, oxygen, and all the monitoring equipment during patient movement and inside the ambulance

Section 2: Isopod Retrieval Outer Ring Zulu Team was started back in March 2020. It was devel- This component consists of one Emergency Physician and one oped as an initiative to assist the hospitals around Klang Valley for Assistant Medical Officer. transportation of ventilated COVID-19 patients, frequently to Hos- Job: pital Sungai Buloh which is Malaysia’s main COVID-19 hospital.  To clear transport pathway In addition to that, Zulu Team is also accountable for emergency  To receive and give instructions for transport direction cases that take place in quarantine centres around Kuala Lumpur.  To give and receive passover reports (X-ray films, patient med- This team started of with 11 members (2 Emergency ical records and personal belonging) Physicians, 8 allied health personnel). As the number of cases and  To counter check the safety aspects of the work process in patient retrievals increase, the Zulu Team has expanded to seventy Inner Ring members to date.

The Zulu Team are comprised of Outer Ring and Inner

Ring. These two components compliment each other in performing safety checks and retrievals. The job scopes of each personnel are as follows4:

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Inner Ring ii) Assistant 2 (Assistant Medical Officer Conclusion i) Team Leader (Emergency Physician/ or Staff Nurse): Based on the daily COVID-19 Medical Officer):  To prepare medications that will be cases that were reported nationwide, we do  To make sure ETT is secure at all used on patient (sedation, inotropes not see any sign that this will be under times and Rocuronium) control soon. Thus, we need to strengthen  Setting up the transport ventilator  To ensure safety line is functioning our capacity and capabilities to guarantee that we are ready to perform our best dur-  Exchange tubing to and fro  To make sure that infusion pumps ing the call of duty and as frontliners of transport ventilator to ward ventila- are function well Malaysia. tor  To administer IV Rocuronium with  To gather all patients information 20cc flush prior to transferring pa- ii) Assistant 1 (Assistant Medical Officer tient from bed to isopod with EP/ or Staff Nurse): MO instructions  To ensure the oxygen port in the  Double pumping transport ambulance is compatible  To ensure vital signs are stable be- with transport ventilator fore single pumping  Assist in patient transfer between  To prepare gauze and sponge hold- bed and stretcher ing forcep to clamp ETT  To apply monitoring devices on  To switch on/off Isopod blower patient (cardiac monitor, blood pressure cuff and SpO2 prob) Between 29th of March to 9th of  To ensure all equipment are safe July 2020, a total of 54 patients were re- and functioning well trieved and directed to COVID-19 tertiary 5  To remind team leader to secure hospital . These cases ranges from zero to ETT and administer IV Rocuroni- three patients per shift. Exponential rise um prior to transfer was noted during waves of the COVID-19  To aid in setting up the Isopod pandemic. The team members were trained on how to manage complications during  To ensure the ventilator is in patient transfer and how to troubleshoot standby mode problems that arises on the spot.  To double check safety

Figure 4: (Left) The first Isopod training with Dr Sarah Shaikh Abdul Karim, Assistant Director of Central Region Covid-19 Unified Command Centre in collaboration with the National Security Council (NSC). (Right) Isopod is in ready-to-roll position

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Figure 5: The team members are ready to go for patient retrieval

Figure 6: The team members after patient retrieval and transfer to dedicated COVID-19 hopital.

Figure 7: The team members post doffing

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MASS TRIAGING AND RETRIEVAL OF COVID-19 PATIENTS

Dr Amira Farhana Abdul Khalil Emergency and Trauma Department, Hospital Kuala Lumpur, Malaysia

COVID-19 pandemic warrants con- tasks is to screen, triage and retrieve COVID-19 health centres, they are equipped and capable of sideration as a mass casualty incident (MCI) of patients from the District Health Offices (PKD) providing the best health care services for low the highest nature. An optimal MCI/disaster in Klang Valley. This operation of mass triaging risk COVID-19 patients. management should consider all four phases of and arranging admission to COVID-19 dedicat- Unlike Category 3 and above, they the so-called disaster cycle which are mitigation, ed hospitals are done in collaboration with hos- mandate intense monitoring and treatment in planning, response, and recovery1. pitals in the Klang Valley, especially Sungai anticipation of their deterioration, and therefore The public health objectives at all stages of the Buloh Hospital under the leadership of Dr. Sarah sent to Hospital Sungai Buloh. They will be preparedness and response plan are to: Shaikh Abdul Karim; Consultant Emergency either be placed in normal wards or intensive  Prevent outbreaks, delay spread, slow and Physician (Fellowship in Prehospital Care and care unit (ICU) if worsens. If a patient recovers stop transmission. Disaster Medicine). or moved down to Category 1 or 2, the patient Patients with COVID-19 illness will be sent to PKRCs until full recovery. All  Provide optimised care for all patients, should have close monitoring of vital signs ac- patients will be given colour-coded stickers especially the seriously ill. cording to phases of illness and monitoring for based on their categories; green for Category 1,  Minimize the impact of the pandemic on progression of disease. Without proper stratifica- yellow for Category 2 and red for Category 3 health systems, social services, and econom- tion, deterioration could occur rapidly despite no prior to transportations. ic activity2. warning at the initial phase. According to the Works Ministry of The Malaysian Government and affil- According to Tan Sri Dr. Noor Malaysia, construction sites in the Klang Valley iated agencies with the guidance of Ministry of Hisham Abdullah (Director General of Health may continue to operate as usual, subject to the Health has formed a structured planning and Malaysia), the majority of COVID-19 patients standard operating procedures. The COVID-19 response to COVID-19; from the implementa- are asymptomatic or only having mild symp- swab tests are mandatory or all construction sites tion of Movement Control Order (MCO) to toms5. Majority of the patients that were within the Klang Valley and not just in COVID- Guidelines of COVID-19 Management in screened are deemed stable and categorised as 1 19 red zones. The PKDs are responsible to con- Malaysia. On top of that, this also includes and 2. Patients from these categories will be sent duct contract tracings and screenings at these setting up Low Risk COVID-19 Quarantine and to PKRC. These patients do not require around areas. These resulted in alarming high numbers Treatment Centre (PKRC). the clock and extensive monitoring of their con- of positive cases than expected. In response to this, Central Region dition. Less man power are required to run these COVID-19 Unified Command Centre was estab- centres. This will certainly help ease the loads lished with the help of the National Security off the main hospitals. PKRCs are also utilised Council (MKN) and led by Selangor Health for step down care from initial admission to Director Dr. Sha’ari Ngadiman. One of the many hospitals. Even though PKRCs are not originally

Figure 1: (Left) Registration, identity confirmatory check by the PKD staff. (Right) As seen is the stand thermometer that was used and the clerking process by the Inner Ring

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This diagram above illustrated the Organization The use of ultrasound as a diagnostic being upfront and honest to them from the get go Chart of Command Control. The Base Com- adjunct is indicated when there are presence of therefore creating awareness amongst them. mander gives instruction and received infor- symptoms or warning signs in a patient. The We have dedicated transportation mation to and from the Field or Mission Com- warning signs are fever of 38 degrees Celcius or team that will arrange the admissions to respec- mander, which will further pass on to the Outer more, heart rate of 120 bpm or more, respiratory tive destinations. There were a few learning and Inner Ring. The Outer and Inner Ring are rate of 20 times/min or more and/or SPO2 95% curves along the way which resulted them to stationed in the red zones with full personal pro- or less. If in the event that a patient with warning work efficiently with each encounter. They have tective equipments (PPEs). A team consist of an signs have any ultrasound findings which is excellent communication skills with the Base Emergency Physician, Medical Officers, Staff suggestive of pneumonia, the patient will Commander and transport hospitals. The Nurses, Assistant Medical Officers and a driver. automatically be labeled as Category 3. transport vehicles will be escorted by police The equipments that were brought with the team After triaging process is completed, officers. are SpO2 probes, thermometers, PPEs, food stuff next would the process of transporting the pa- In conclusion, Teamwork is very im- for the team and decontamination supplies. tients to respective areas based on their catego- portant between the hospitals, PKDs and the sites There are a lot of potential problems ries. Arranging these patients prior to transport is managements especially in terms of logistic issue that were encountered along the process. We extremely crucial to prevent patients from run- and crowd control. Jabatan Bomba and PDRM started with identifying their names and passport/ ning away or transported to the wrong destina- occasionally do step in to aid as well. This initia- IC numbers. Some of the patients had similar tion. As an example, patients in Category 1 and 2 tive will continuously will help in early detection common names which can be confused at times. are physically arranged based on their registra- and treatment of patients, curb the spread of (Example: Mohamad, Bahadur, Islam, Miah, tion numbers in proper order. Identifications and COVID-19, aid in efficient use of available man- Aung). It is important to get their ID right in the vitals signs are checked repeatedly for quality power and resources efficiently and give team beginning to ensure the process flows smoothly. control. If a vital sign does reflect Category 3 or members learning opportunities. This will also Once they are correctly identified, they will get a more, the vital signs and examinations are re- will go down in history as one of the ways Ma- sticker with their personal registration number. peated to avoid error or mistriaging. laysia fought the ‘war’ of COVID-19. The information are entered into a standardised Among the places that our team had Google Sheet form which will be monitored by the opportunity to partake were the Malaysia the Base Commander. Unpredictable factors such Agro Exposition Park Serdang (MAEPS), immi- as the weather, the suitability of the site (e.g. gration detention centres (DTI), Top Glove Cor- size, humidity) were also the hurdles the team poration in Klang, Tamu Hotel, Seri Pacific had to deal with on every mission. Hotel, Ancasa Hotel, Kuala Lumpur Internation- The next stage of the triaging is to al Hotel and the most recent, Sky Meridien con- gather vitals signs that were required including struction site. We were very happy to see Tan Sri saturation of oxygen, heart rate, respiratory rate DG himself and our beloved Hospital Director, and temperature. At this point, we should be able Datuk Dr Heric Corray at ground level oversee- to pick up warning signs (if any). Age, co- ing the whole triaging process at the latter. Some morbids and symptomology were also apart of of the mission numbers ranged from 20 - 1200 the screening process. A positive COVID-19 patients per day depending on the site. patients tend to desaturate even on minimal exer- From our various experiences, we had tion, therefore patients were asked to do a Sit-to- found that the patients who came for the screen- Stand Test for one minute to assess exercise- ing do not even know that they were positive for induced oxygen desaturation6,7. This test is vali- COVID-19. This saddened us because the pa- dated, it is proven safe, it is used globally and tients ought to be given proper briefing of the can be conducted anywhere. They are likely to diagnosis, treatment course and breaking the bad be specific but not sensitive8. news to them. This can perhaps be improved by

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Figure 2: (Left) Improvisation of the equipment available, stretcher used as table on site. (Right) Selected construction site used as screening place

Figure 3: Screening and triaging area at Top Glove, Klang.

Figure 4: Patients were arranged according to their category before they were loaded into the bus

Figure 5: (Left) Heavy rain and strong wind did not stop the team from continuing the screening process (Right) The use of color-coded stickers to categorise the patients

Figure 5: (Left) Team members all prepped and ready to start screening process (Right) Site visit by Director-General Health Malaysia, Tan Sri Dr Noor Hisham Abdullah . PAGE 2 3 CRCHKL E-NEWSLETTER ISSUE 7 2020 ROLE OF MODIFIED SNORKELLING MASK NIPPV DEVICE IN COVID-19 AND SARI PATIENTS.

Nurul Liana Binti Roslan, Shamala Nair Sugu Kumaran, Mahathar Abd. Wahab Emergency and Trauma Department, Hospital Kuala Lumpur, Malaysia

The World Health Organization also briefly came to a halt due to major by exposure to ultraviolet (UV) light. The (WHO) declared the outbreak of COVID-19 medical and pharmaceutical conglomer- particle size is between 15-25um 2. UV as a global pandemic in March 2020. ates focusing on coping with internal de- light lamps were used to charge the pow- There are more than 213 countries affect- mands. As the saying goes, necessity is der resulting in a glow-in-the-dark material ed including Malaysia. In Malaysia, 49730 the mother of inventions, and during these that can assist in locating surface contami- of confirmed cases of COVID-19 has been times of scarcity, physicians sorted to in- nation. Monnal T60® ventilator was used reported, with 318 deaths (0.6%) 1. Emer- vent different prototypes of Non-invasive and leakage from the circuit and mask seal gency and Trauma Department of Hospital Positive Pressure Ventilation (NIPPV) de- to the face was studied. The volunteer held Kuala Lumpur (ETD HKL) has been desig- vices to battle the shortage. The idea of the powder inside the mouth and simulated nated as one of the screening and treat- using snorkelling masks as Non-invasive coughing after completing the leak test. The ment centers for all suspected and con- Ventilation (NIV) interface originated from experiment was recorded using the video firmed COVID-19 cases by the Ministry of an Italian physician, Dr. Renato Favero. features on iPhone 11 Pro Max (240fps). Health Malaysia (MOH). Together with the engineers at Isinnova, Debating data have been pub- they designed a new component called the As the death toll continues to rise lished in regards to the benefits vs deleteri- ‘Charlotte valve’; an adapter that connects due to this deadly severe acute respiratory ous effects of NIPPV in COVID-19 patients the mask to the gaseous source4. syndrome coronavirus 2 (SARS-CoV-2) 11,12,13,14. In practice, NIV is not used

infection, healthcare workers (HCW) need We studied the safety and ap- for SARI / COVID -19 patients at our center to be well prepared and better equipped. plicability of this novel modified snorkelling to abate the risk of delayed intubation and Learning from other countries' experiences, mask that has become available in our exposure of HCWs to aerosol droplets. MOH sorted to purchase more ventilators center as an NIV interface. The experiment Also, studies have shown a high rate of and other medical equipment as one of its was done in a darkened room. The pho- NIV failure in severe hypoxaemic patients. preparedness measures. This emerging to luminescent powder was used to However, during this time of crisis and disease outbreak forced countries world- represent contaminated secretions and to scarce resources, physicians may consid- wide to restrict movement by closing their allow better visibility upon detecting leak- er alternatives to intubation and the need borders causing massive delays in medical age on the mask. This non-toxic powder is for ventilatory support. supply deliveries. Export of these goods a light-emitting material that is activated

Figure 1: The modi- fied snor- keling mask NIPPV de- vice’s com- ponents.

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Figure 2: The assembly of the modified snorkelling mask NIPPV device. The 3D-printed adapter needs to be attached to the mask. We used medical tape to reinforce the loose connection and to prevent it from dislodging.

The goals of NIV are to maintain sufficient alveolar the mask as PPEs instead of as ventilatory devices for sick ventilation, improve gas exchange, and decrease work of patients 9. We proposed HCWs to have personalised breathing. However, successful outcomes depend on many masks due to hygiene purposes and different sizing which factors including the proper interface fitting. According to requires an individualised mask-seal. Luján et. al. (2018), tidal volume in a spontaneously breath- COVID-19 or SARI patients should be using NIV in ing patient varied according to the device and mask fitting. an isolated negative pressure room if there is no ventilator Even with the perfect fit, the magnitude of leakage is di- available. In the event of inadequate PPE, HCWs may con- verse 2,8. The difference between inspired and expired sider using this modified device while performing aerosol- volume corresponds to the leakage. The acceptable per- generating procedures. A larger-scale study is needed to centage of leakage is less than 20%. This value is derived evaluate the outcome of patients using this innovative inter- from the compressible volume (the amount of gas com- vention. The cost-effectiveness and safety profile of modi- pressed in the circuit for every pressure generated by the fied snorkelling masks in delivering NIV however needs to ventilator during the inspiratory phase) 2. During our study, be further enhanced and refined. no leakage detected during the leak test whilst using the Link to the video:https://drive.google.com/file/ ventilator at the PEEP of 0 cmH20. This suggests that the d/1n02tnsSps08qDHbr6h1CzJ2m7aoDrMK7/view? mask size is appropriate and well-fitted for the volunteer. usp=drivesdk We further increased the PEEP up to 5 cmH2O for 5 minutes in which a significant volume of leakage was Disclaimer: This experiment was done as an initiative of observed. A close inspection performed under UV light physicians in battling COViD-19. No financial incentives detected a minimal amount of powder leaked on both sides were received by the authors. No harm occurred during this of the mask. The photo luminescent powder was found be- experiment. yond the inner borders of the mask. Therefore, the safety of applying this device on SARI or COvID-19 patients needs to be further evaluated especially if used in a positive pressur- ized room. We need to highlight that we did not measure tidal volume (TV) nor quantify the volume of leakage in this study.

Cleaning and disinfecting modified snorkelling mask is challenging due to the design of the silicon seal. We were still able to detect the powder under UV light after washing it thoroughly twice with distilled water and soap. As the mask is commercially available and considered safe for non-infective persons, we support the idea of HCWs using

PAGE 25 CRCHKL E-NEWSLETTER ISSUE 7 2020 COVID-19 JOURNEY

DEPLOYMENT OF CRC STAFF FOR COVID WARD ROTATION IN HKL.

 Dr Karina Koh  Dr Lee Jen Ven  Dr Noor Hidayu Wahab  Dr Raj Kumar A/L Sevalingam  KJ Azura Ramli

DEPLOYMENT OF CRC STAFF FOR COVID-19 CARE ROTATION OUTSIDE HKL.  Dr Nor Aliya Ayub : Pusat Kuarantin dan Rawatan COVID-19 (PKRC), MAEPS, Serdang.  Dr Nadiah Ismail : COVID-19 Quarantine Centre  Dr Nik Nur Eliza Mohamed : COVID-19 Quarantine Centre  Dr Raj Kumar A/L Sevalingam: Semporna, Sabah.

PAGE 26 CRCHKL E-NEWSLETTER ISSUE 7 2020 COVID-19 JOURNEY

DEPLOYMENT/ATTACHMENT OF STAFF TO BILIK GERAKAN/CPRC

 Dr.Nurdiana Hussin (Bilik Gerakan HKL)

 Dr.Nadiah ismail (Bilik Gerakan OSH)

 Dr Noorhidayu Wahab (PKD Titiwangsa)

 Dr Siti Zubaidah Othman(PKD Titiwangsa)

 Dr Nor Aliya Ayub (PKD Cheras)

 Dr Nur Aisyah Abdul Rahim (PKD Titiwangsa)

 Dr Mohd Azizuddin Amir Shariffuddin (COVID-19 Mental Health & Psychological Counseling Support for Healthcare Workers )

PAGE 27 CRCHKL E-NEWSLETTER ISSUE 7 2020

COVID-19 JOURNEY

 Faceshield production by CRC staff during early outbreak

RESEARCH ACTIVITIES

 Assessment of Serological Response and Potential Risk Factors for COVID-19 Infection Among Healthcare Workers- Dr Nor Aliya Ayub, Dr Raj Kumar, KJ Azura Ramli, PPP Muhammad Al-Hafiz

PAGE 28 CRCHKL E-NEWSLETTER ISSUE 7 2020 COVID-19 JOURNEY

RESEARCH ACTIVITIES

 A Descriptive Study on the Clinical Characteristics of COVID-19 Infections in Malaysia - Dr Siti Zubaidah Othman, Dr Noorhidayu Wahab, Dr Nik Nur Eliza, Dr Nadiah Ismail

 The effects of vitamin C supplementation in the treatment for COVID-19: A multi-centre prospective observational study - Dr Nadiah Ismail.

 WHO Solidarity Trial - Dr Karina Koh, Dr Lee Jen Ven, Dr Nadiah Ismail

 Case Series SARI/COVID-19 in HKL - Dr Duratul’ain Mohamad Nazri, Dr Nur Aisyah Abdul Rahim, KJ Azura Ramli.

PAGE 29 CRCHKL E-NEWSLETTER ISSUE 7 2020 RESEARCH POSTER

PAGE 30 CRCHKL E-NEWSLETTER ISSUE 7 2020

RESEARCH POSTER

PAGE 31 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [JANUARY]

Impact Author Research Title Journal Department Factor Kin Fon Leong Trachyonychia The Journal of Paediatric 2.77 Paediatric Clinical, Biochemical and Mutational Findings M. Mardhiah, Nor Azimah Abdul Molecular Genetics and in Biotinidase Deficiency Among Malaysian 0.51 Genetic Azize, Yusnita Yakob, Ngu Lock Hock Metabolism Reports Population Treatment Options for Turf Toe: A Systematic The Journal of Foot and Tengku Nazim Tengku Yusof 0.62 Orthopaedic Review Ankle Surgery Skin pH Mapping and Its Relationship with Zainal Hazleen, Adawiyah Jamil, Transepidermal Water Loss, Hydration and Skin Research Technology 0.16 Dermatology Norazirah Md Nor, Tang Min Moon Disease Severity in Adult Patients with Atopic Dermatitis Minimal Agreement Between Basophil Allergologia et Tang Min Moon Activation Test and Immunoassay in 1.276 Dermatology Immunopathologia Diagnosis of Penicillin Allergy Bernard Yu-Hor Thong, Michaela Drug Hypersensitivity Reactions in Asia: Asia Pacific Allergy 1.826 Dermatology Lucas, Tang Min Moon Regional Issues and Challenges Chin Chin Ch’ng, Loke Meng Ong, Kelvin Khai Meng Beh, Wan Shaariah Survival Advantage of Initiating Dialysis in Md Yusuf, Thian Fook Asian Pacific Society of Elderly and Non-Elderly Incident End Stage 0.59 Nephrology Chew, Ming Lee Lee, Lai Seong Hooi, Nephrology Kidney Disease Patients Hin Seng Wong, Shahnaz Shah Fir- daus Khan, Ghazali Ahmad Recent Patents on Kin Fon Leong Tinea Capitis: An Updated Review Inflammation & Allergy 0.44 Paediatric Drug Discovery Nguk Chai Diong, Benedict Growing Teratoma Syndrome of Mediastinal Annals of Thoracic Surgery Dharmaraj, Cindy Thomas Joseph, 0.5 Nonseminomatous Germ Cell Tumor Medicine Anaesthesiology Narasimman Sathiamurthy Evaluation of Contrast-Enhanced Digital Mammography (CEDM) in The Preoperative Maninderpal Kaur Gill The Breast Journal 0.66 Radiology Staging of Breast Cancer: Large-Scale Single-Center Experience Dhayalen Krishnan, Siti SM Zaini, Radiology Neurosyphilis Presenting as Acute ischemic Kartikasalwah A Latif, Joyce Pauline Clinical Medicine 0.46 Medical Stroke Joseph Neurology Sie Chong Doris Lau, Mohamed Najib Mohamed Unni, Kok Hoi The, Mimi Autologous Stem Cell Transplantation Azura Aziz, Zulaiha Muda, Shoba Following High-Dose Chemotherapy in Paediatric Paediatric Blood & Cancer 1.14 Anne Thomas, Shiao Wei Quah, Children with High-Risk Neuroblastoma: Pathology Hishamshah Ibrahim, Ida Shahnaz Practicality in Resource-Limited Countries Othman Yew Keong Ng, Noraida Mohamed Patient-Centred Care in the Context of Shah, Ly Sia Loong, Lay Ting Pee, Pharmacy Consultations: A Qualitative Study Journal of Evaluation in 0.59 Pharmacy Wei Wen Chong with Patients and Pharmacists in Malaysia Clinical Practice Yek-Ching Kong, Li-Ping Wong, Chiu-Wan Ng, Nur Aishah Taib, Nanthini Thevi Bhoo-Pathy, Understanding The Financial Needs Following Oncology and Mastura Mohd Yusof, Azlina Firzah Diagnosis of Breast Cancer in A Setting with The Oncologist 2.61 Radiotherapy Aziz, Prathepamalar Yehgambaram, Universal Health Coverage Wan Zamaniah Wan ishak, Cheng-Har Yip, Nirmala Bhoo-Pathy Syahril Rizal Arsad, Sei Haw Sem, Hemi-Hamate Arthroplasty in Chronic Jeremy Prakash Silvanathan, Fracture-Dislocation of Proximal Cureus - Orthopaedic Rashdeen Fazwi, Muhammad Interphalangeal Joint of Fingers: Nawawi A Report of Two Cases

PAGE 32 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [JANUARY]

Impact Author Research Title Journal Department Factor Grave Prognosis of The Musclespecific Kinase Annals of Indian Academy Fu Liong Hiew (Musk)-Positive Myasthenia Gravis (MG): 0.33 Neurology of Neurology A False Prejudice Lichen Striatus with Nail involvement in A Case Reports in Kin Fon Leong - Paediatric 6-Year-Old Boy Paediatrics Malaysian Journal of Karen Michell Othaya Kumar, Nasopharyngeal Cancer : Geographic Medicine and Health 0.12 Genetic Rabiatul Basria S.M.N. Mydin Variation and Risk Factors Sciences Mansharan Kaur Chainchel Singh Correlation and Assessment of Coronary Saiful Nizam Abdul Rashidd, Suzana Artery Luminal Stenosis: Post-Mortem Forensic Science Abdul Hamide, Mohd Shah 0.87 Forensic Computed Tomography Angiogram versus International Mahmood, Siew Sheue Feng, Histopathology Hapizah Mohd Nawawi, Effat Omar Intracranial Volume Post Cranial Expansion Shukriyah Sulong, Azmi Alias, Surgery Using Three-Dimensional Computed The Journal of craniofacial Fadzlishah Johanabas, Johari Yap 0.44 Neurosurgery Tomography Scan Imaging in Children with surgery Abdullah, Badrisyah Idris Craniosynostosis Vitamin D Status in a Monocentric Cohort of Systemic Lupus Erythematosus (SLE) Patients Medical Journal of Ong Swee Gaik, Ding Hui Jen 0.23 Medical and Correlations with Clinical and Malaysia Immunological Profile Rahayu Draman, Rabeya Yousuf, A Preliminary Study on Coagulation Indian Journal of Suria Abdul Aziz, Chuan Hun Ding, Parameters and Sterility of Thawed Refrozen Haematology & Blood 0.21 Pathology Suzana Zainol, Chooi Fun Leong Fresh Frozen Plasma Transfusion International Journal of Cavernous Haemangioma: A Rare Cause of Nur Dini Jalaludin Human and Health - Pathology Hoarseness in Adults Sciences

PAGE 33 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [FEBRUARY]

Impact Author Research Title Journal Department Factor Standardised Neonatal Parenteral Nutrition Chee Sing Wong Formulations - Australasian Neonatal Parenteral BMC Pediatrics 0.85 Paediatric Nutrition Consensus Update 2017 Hamidah Alias, Sasirekha Krisnan Behavioral Outcome Among Survivors of Morthy, Syed Zulkifli Syed Zakaria, BMC Pediatrics 0.85 Paediatric Childhood Brain Tumor: A Case Control Study Zulaiha Muda, Azmi Mohd Tamil

Kai Wei Lee, Siew Mooi Ching, Fan Kee Neonatal Outcomes and its Association Among Hoo, Noraihan Mohd Nordin, Gestational Diabetes Mellitus with and without Obstetric and Midwifery 0.84 Navin Kumar Devaraj, Ai Theng Cheong, Depression, Anxiety and Stress Symptoms in Gynaecology Yook Chin Chia Malaysia: A Cross-Sectional Study

Choong Yi Fong, Fen Ni Ong, Lai Choo Vitamin D Deficiency and Insufficiency in Nature, Spinal cord 0.72 Paediatric Ong, Teik Beng Khoo, Ming Lee Lee Malaysian Children with Spina Bifida Network Analysis of the Depressive Symptom Profiles in Asian Patients with Psychiatry and Clinical Chee Kok Yoon Depressive Disorders: Findings from The Research 1.14 Psychiatry Neurosciences on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) Psychological Mindedness as a Mediator in the Nicholas Tze Ping Pang, Ruziana Relationship Between Dysfunctional Coping Styles Perspectives in Psychiatric 0.44 Psychiatry Masiran, Kit‐Aun Tan, Aminah Kassim and Depressive Symptoms in Caregivers of Care Children with Autism Spectrum Disorder Retrospective Cohort Study of 68 Sacral Giant Cell Tumours Treated with Nerve-Sparing Surgery and Chiao Yee Lim The Bone & Joint Journal 2.38 Orthopedic Evaluation on Therapeutic Benefits of Denosumab Therapy Therapeutic Plasma Exchange (TPE) for Keng Seng Fu, Pei Yin Wong, Fu Liong Semi-Critical Neurology Presentations in a BMJ 3.27 Neurology Hiew Non-Acute Neurology Set-Up: Clinical Practice and Challenges Simplifying Surgery in Haemophilia B: Low Factor Pusat Darah Faraizah Abdul Karim IX Consumption and Infrequent Infusions in Thrombosis Research 1.04 Negara Surgical Procedures with Rix-F Grave Prognosis of the Musclespecific Kinase Annals of Indian Academy of Fu Liong Hiew (Musk)-Positive Myasthenia Gravis (MG): A False 0.33 Neurology Neurology Prejudice Norazirah Md Nor, Sabeera Begum Food Restriction, Nutrition Status and Growth in Pediatric Dermatology 0.51 Paediatric Kader Ibrahim, Bee Koon Poh Toddlers with Atopic Dermatitis Review of CHESS Score in SAH Patients in Local Journal of Neurosciences in Sze-Voon Yee, Abdul Rahman Ghani, 0.3 Neurosurgery Azman Raffiq Malaysian Population Rural Practice Factors Influencing Professional Help-Seeking Daniel Teck Lung Wong, Seng Fah Behavior during First Episode Psychosis in Schizo- Tong, Tuti Iryani Mohd Daud, Frontiers in Psychiatry 1.23 Psychiatry phrenia: An Exploratory Study on Caregivers’ Salina Abdul Aziz, Marhani Midin Perspective “A Double-Edged Sword”: A Case Report on Liver Borneo Journal of Medical Azlina Ibrahim, Alvin Oliver Payus Injury Side-Effect of Anti-Tuberculosis Drug on - Medical Sciences Liver Tuberculosis Patient The Use of Complementary and Alternative Kaitian Koo, Rushitaa Nagayah, Complementary Therapies in Paediatric Medicine in Children with Atopic Eczema at a Ter- 0.58 Sabeera Begum Medicine Pharmacy tiary Care Centre in Malaysia Conference Proceedings, Priscilla Dasa, Nyi Nyi Naing, Nadiah Depression, Anxiety and Coping Styles in Patients 3rd USM-International Wan-Arfah, KON Noorjand, Yee Cheng - Neurology with Brain Pathology in a Malaysian Hospital Conference On Social Kuehe, Kantha Rasalingam Sciences 2019 Retrospective Cohort Study of 68 Sacral Giant Cell Tumours Treated with Nerve-Sparing Surgery and Lim Chiao Yee The Bone and Joint Journal 4.306 Orthopedic Evaluation on Therapeutic Benefits of Denosumab Therapy

PAGE 34 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [MARCH]

Impact Author Research Title Journal Department Factor Are Malaysian Type 2 Diabetes Patients Siti Fatimah Badlishah-Sham, Anis Willing to be Trained to Speak to Their Off- Safura Ramli, Mohamad Rodi isa, BMC Family Practice 1.06 Medical Spring About Risk of Diabetes and Preventive Nurzakiah Mohd Zaki Measures? Azura Mohd Affandi, Ch’ng Chin Chwen, Heah Sheau Szu, Leow Dermatology Wooi Leong, Noor Zalmy Azizan, Management of Atopic Eczema in Primary Malaysian Family 0.17 Paediatric Sabeera Begum, Zaridah Zainuri, Care Physician Pharmacy Siti Mariam Tukimin

Kaitian Koo, Rushitaa Nagayah, The Use of Complementary and Alternative Sabeera Begum, Tuan Mazlelaa Paediatric, Medicine in Children with Atopic Eczema at a Complementary Therapies 0.58 Tuan Mahmood, Noraida Mohamed Pharmacy Tertiary Care Centre in Malaysia in Medicine Shah Analysis of Internet Searches Using Google Photodermatol Trends to Measure Interest in Sun Protection Suganthy Robinson Photoimmunol 2.387 Dermatology and Skin Cancer in Selected South-East Asian Photomed Populations Clinical and Radiological Results of The Archives of Orthopaedic Anizar Faizi Anoar Vascularized Medial Femoral Condyle Graft 1.15 Orthopedic and Trauma Surgery for Scaphoid Non-Union The State of Neurosurgical Training and Mohd Raffiz Mohd Ali Education in East Asia: Analysis and Strategy Neurosurgical Focus 1.29 Neurosurgery Development for This Frontier of The World

Nor Salhana Mohammed Wazir, Psychosis During Multidrug Resistant Malaysian Journal of - Psychiatry Tee Chun Keat Tuberculosis Treatment: A Case Report Psychiatry A Retrospective, Observational Study to Ros Suzanna Ahmad Bustamam, Determine The Patient and Tumor Yu Kong Leong, Flora Li Tze Chong, Oncology and Characteristics of HER2-Positive Breast Asian Journal Oncology - Florence Wong Yoke Fui, Yew-Teik Radiotherapy Cancer Patients Treated at Five Main Public Cheong, Goh Kenny Cancer Centers in Malaysia Lung-Protective Mechanical Ventilation Pediatric Critical Care Siew Wah Lee Strategies in Paediatric Acute Respiratory 1.21 Paediatric Medicine Distress Syndrome Delineation of Musculocontractural Charlotte Kvist Lautrup, Molecular Genetic Ehlers-Danlos Syndrome Caused by 0.9 Genetic Keng Wee Teik Genomic Medicine Dermatan Sulfate Epimerase Deficiency A Case of G1013R FBN1 Mutation: Kavitha Rethanavelu, American Journal of A Potential Genotype–Phenotype Correlation - Genetic Jasmine L. F. Fung Medical Genetics in Severe Marfan syndrome

PAGE 35 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [APRIL]

Impact Author Research Title Journal Department Factor Yi Hui Foo, Tunku Sara Tunku Ahmad Photobiomodulation After Neurotization Photobiomodulation, Yahaya, Tze Yang Chung, and Jeremy (Oberlin Procedure) in Brachial Plexus Injury: Photomedicine and Laser - Orthopedic Prakash Silvanathan A Randomized Control Trial Surgery United in Fight Against Prostate Cancer (UFO) Registry: First Results from A Large, Azad Hassan Abdul Razack, Noor Multi-Centre, Prospective, Longitudinal BJU International 2.01 Urology Ashani Md Yusoff Cohort Study of Advanced Prostate Cancer in Asia Harikrishna K. R. Nair, Sylvia SY Validation of Harikrishna Periwound Skin Journal of Wound Care 0.59 Medical Chong, Abdul Manan Othman Classification for Wound Assessment Ganapathi P, Nurul Yaqeen ME, It is Not Asthma! An Arcane Case of 'Scimitar' Medical Journal of 0.23 Medical Zamzurina AB Syndrome: A Case Report Malaysia Alexander K C Leung, Kin Fon An Ulcerated Giant Segmental Hemangioma Paediatric & Child Health 0.54 Paediatric Leong, Joseph M Lam Resulting in Contracture of The Left Elbow Factor VIII Activity and Bleeding Risk During Pusat Darah Faraizah Abdul Karim Prophylaxis for Severe Hemophilia A: Haematologica 2.93 Negara A Population Pharmacokinetic Model Kay Ly Chng, Poh Soon Lai, Methanol Related Death in National Institute Malaysian Journal of Sheue Feng Siew, Siti Wira Md Yaro,of Forensic Medicine, Hospital Kuala Lumpur: 0.23 Forensic Pathology Mohd Shah Mahmood A Case Series Fadzwani B., Raha A.R., Nadia M.N., Surgical Antibiotic Prophylaxis: Incidence and IIUM Medical Journal Wan Rahiza WM., Razman J., and 0.14 Anaesthesiology Risk of Surgical Site Infection” Malaysia Nordiah A.J Judith Ju-Ming Wong, Herng Lee Tan, Characteristics and Trajectory of Patients Siew Wah Lee, Kenneth Tou En with Pediatric Acute Respiratory Distress Pediatric Pulmonology 0.93 Paediatric Chang, Yee Hui Mok, Jan Hau Lee Syndrome High Expression of LC3A, LC3B and Malaysian Journal of Subasri Armon P62/SQSTM1 Autophagic Proteins in Human 0.23 Pathology Pathology Colonic Ganglion Cells Muhammad Aminuddin Ashari, isa Strategies for Radiology Departments in Diagnostic and 0.65 Radiology Azzaki Zainal, Faizah Mohd Zaki Handling The COVID-19 Pandemic Interventional Radiology Afshan Sumera, Nur Diana Anuar, Ammu Kutty Radhakrishnan, A Novel Method to Identify Autoantibodies Hishamshah Ibrahim, Nurul H Rutt, Against Putative Target Proteins in Serum Biomedicines 1.51 Paediatric Nur Hafiza ismail, Ti-Myen Tan, from Beta-Thalassemia Major: A Pilot Study Abdul Aziz Baba Karmila Abu Bakar, Khairunnisa Khalil, Yam Ngo Lim, Yok Chin Yap, Adrenal Insufficiency in Children with Mirunalini Appadurai, Sangeet Nephrotic Syndrome on Corticosteroid 0.87 Paediatric Sidhu, Chee Sing Lai, Azriyanti Anuar Frontiers in Pediatrics Treatment Zaini,Nurshadia Samingan, Muhammad Yazid Jalaludin De Novo Variants in CUL3 are Associated Journal of Human Ngu Lock Hock with Global Developmental Delays with or 1.39 Genetic Genetics Without Infantile Spasms Late Complications Caused by the Neglected Lai Teck Gew Endoscopy 1.48 Medical Biliary Stent Asrul Akmal Shafie, Azuwana Supian, Mohamed Azmi Ahmad Hassali, Rare Disease in Malaysia: Challenges and Public Library of Science 1.02 Genetic LockHock Ngu,Meow-Keong Thong, Solutions One Hatijah Ayob,

De Novo Truncating Variants in The Last American Journal of Ahmad Rithauddin Mohamed Exon of SEMA6B Cause Progressive 7.38 Paediatric Human Genetics Myoclonic Epilepsy

PAGE 36 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [MAY]

Impact Author Research Title Journal Department Factor Yin Ye Lai, Intan Nureslyna Samsudin, Normaizuwana Persistent Hyponatremia in an Elderly Clinical Chemistry 1.92 Pathology Mohamed Mokhtar, Patient Subashini C. Thambiah Jamuna Rani Appalasamy, Joyce Video Narratives intervention Among Stroke Pauline Joseph, Siva Seeta Ramaiah, Survivors: Feasibility and Acceptability Study Journal of Medical - Neurology Anuar Zaini Md Zain, Kia Fatt Quek, of A Randomized Controlled Trial Internet Research Aging Kyi Kyi Tha Raevathi Omasanggar, Choo Yee Yu, Mitochondrial DNA Mutations in Malaysian Public Library of Science Geik Yong Ang, Nor Aina Emran, 1.02 Surgery Female Breast Cancer Patients one Normayah Kitan, Anita Baghawi Raevathi Omasanggar, Choo Yee Yu, Mitochondrial DNA Mutations in Malaysian Public Library of Science Geik Yong Ang, Nor Aina Emran, 1.02 Surgery Female Breast Cancer Patients one Normayah Kitan, Chee Chung Liu, Adzleen Mohmood, Intra-Arterial Chemotherapy for Public Library of Science Norhafizah Hamzah, Jia Him Lau, Retinoblastoma: Our First Three-and-A-Half 1.02 Ophthalmology one Nurliza Khaliddin, Jamalia Rahmat Years' Experience in Malaysia Species Distribution and Clinical Profiles of Siti Norbaya Masri, Wan Nazirah Coagulase-Negative Staphylococci (Cons) The Medical Journal of 0.23 Pathology Wan Abu Bakar, Salbiah Hj Nawi Isolated from Blood Cultures Among Malaysia Paediatric Patients in Hospital Kuala Lumpur Ann Nie Kong, Choong Yi Fong, Ching Association of Common Genetic Variants Ching Ng, Ahmad Rithauddin with Vitamin D Status in Malaysian Children Seizure 0.85 Paediatric Mohamed with Epilepsy Boon Yean Chai, Wai Kien Yip, Loss of interleukin-17RA Expression is Pathology Oncology Noraini Dusa, Norhafizah Associated with Tumour Progression in 0.69 Pathology Research Mohtarrudin, Heng Fong Seow Colorectal Carcinoma Determining Standardized Causes of Death of

Thahira Jamal Mohamed, Infants, Children, and Adolescents Living with 2.45 Paediatric AIDS Journal HIV in Asia Raevathi Omasanggar, Choo Yee Yu, Mitochondrial DNA Mutations in Malaysian Geik Yong Ang, Nor Aina Emran, Public Library of Science 1.02 Surgery Female Breast Cancer Patients Anita Baghawi one The Asia Pacific Hidradenitis Suppurativa Moonyza Akmal Ahmad Kamil (Aphis) Foundation: Promoting Hidradenitis International Journal of 0.61 Dermatology Suppurativa Research in The Asia Pacific Dermatology Dyoi E Low, Ahmad Fauzi HLA-B*58: 01 Association in Nurul-Aain, Wooi Chiang Tan, Allopurinol-induced Severe Cutaneous Pharmacogenetics and Mohammed Faizal Bakhtiar, Shahnaz Adverse Reactions: The Implication of 0.77 Dermatology Genomics Murad, Choong Chor Chang, Chun Ethnicity and Clinical Phenotypes in Lai Too, Min Moon Tang Multiethnic Malaysia Kai Wei Lee, Siew Mooi Ching, Fan Factors Associated with Poor-to-Moderate Kee Hoo, Vasudevan Ramachandran, Quality of Life Among Pregnant Women with Obstetric and Quality of life Research 1.12 Seng Choi Chong, Noraihan Mohd Gestational Diabetes Mellitus: Gynaecology Nordin, Navin Kumar Devaraj A Cross-Sectional Study in Malaysia Platelet-Rich Plasma Injection for the Treatment of Hamstring injuries: The American Journal of Tengku Nazim Tengku Yusof 3.24 Orthopedic A Systematic Review and Meta-Analysis with Sports Medicine Best-Worst Case Analysis

Harikrishna Kr Nair Non-Healing Venous Leg Ulcer 0.59 Medical Journal of Wound Care

PAGE 37 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [MAY]

Impact Author Research Title Journal Department Factor Jian Lynn Lee, Noraida Mohamed A Systematic Review and Meta-Regression Shah, Mohd Makmor-Bakry, Farida Analysis on The Impact of Increasing IgG Hanim islahudin, Hamidah Alias, Through Level on Infection Rates in Primary Journal of Clinical 1.58 Paediatric Lokman Mohd Noh, Shamin Mohd Immunodeficiency Patients on Intravenous Immunology Saffian IgG Therapy Efficacy and Safety of Rix-FP in Surgery: Pusat Darah Faraizah Abdul Karim Thrombosis Research 1.04 An Update from A Phase 3b Extension Study Negara Yue Hui Lau, Hazfadzila Mohd Temporal Dispersion in Demyelination of Clinical Neurophysiology Unit, Lay Peng Lee, Weng Khean 0.58 Neurology POEMS Syndrome and Castleman Disease Practice Loh, Fu Liong Hiew Asrul Akmal Shafie, Irwinder Kaur Health-Related Quality of Life Among Chhabra, Jacqueline Hui Yi Wong, Children with Transfusion-Dependent Health and Quality of Life Paediatric Noor Syahireen Mohammed, 1 Thalassemia: A Cross-Sectional Study in Outcomes Pharmacy Hishamshah Mohd Ibrahim, Malaysia Hamidah Alias MIBG Therapy for Large Relapsed Reana Devi Arunasalem, Ahmad Pheochromocytoma and Inoperable The International Journal Nuclear - Zaid Zanial Paraganglioma: Case Series and Literature of Medicine and Sciences Medicine Review Alexander K C Leung, Benjamin Henoch-Schönlein Purpura in Children: 0.36 Paediatric Barankin, Kin Fon Leong An Updated Review Current Pediatric Reviews Alexander K C Leung, Joseph M Lam, Infantile Hemangioma: An Updated Review 0.36 Paediatric Kin Fon Leong, Kam Lun Hon Current Pediatric Reviews Ammar Manas, Mohd Yazid Isolated Tuberculosis of The Wrist: Bajuri, Rashdeen Fazwi Muhammad Cureus - Orthopedic Subtle But Destructive Nawawi Successful Spontaneous Pregnancy After Fatimahtulzahrah Saparmin, Precision Radiation Radiotherapy Pelvic Radiotherapy for a Sacral Giant Cell - Vaishnavi Jeyasingam Oncology and Oncology Tumor: A Case Report Sivakami Janahiraman, Chan Yen Effect of an Intensive Patient Educational Tay, Jie Min Lee, Wen Ling Lim, Programme on The Quality of Bowel BMJ Chun Hoe Khiew, Irina ishak, Zakry 0.96 Pharmacy Preparation for Colonoscopy: A Single-Blind Open Gastroenterology Yahya Onn, Mohd Razali Ibrahim, Randomised Controlled Trial Chun Keat Chew Neshalene Ratnakrishnan, Roslinah The International Journal Case series of Ocular Bartonellosis 2.399 Ophthalmology Muji, Wan Haslinah of Medicine & Sciences Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) Diagnosed by Controlled Moonyza Akmal Ahmad Kamil, International Journal of Attenuation Parameter on Transient 2.067 Dermatology Suganthi Thevarajah Dermatology Elastography and its Predisposing Factors in Psoriasis Neshalene Ratnakrishnan, Roslinah The International Journal Case series of Orbital Cellulitis 2.399 Ophthalmology Muji, Wan Haslinah of Medicine & Sciences

PAGE 38 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [JUNE]

Impact Author Research Title Journal Department Factor Woh Yon Mak, Jivanraj R. Nagarajah, Hannah Abdul Halim, Anitha Ramadas, Dipeptidyl Peptidase-4 inhibitors Use in Type II BMJ open gastroenterology 0.96 Pharmacy Zulsairi Mohd Pauzi, Lay Ting Pee, Diabetic Patients in A Tertiary Hospital Nirmala Jagan Effectiveness of Decision Aid in Men with Localized R. Malek, M. Sundram, S. Omar, J. R. Prostate Cancer: A Multicenter Randomized Journal of Cancer Education 0.56 Urology Sathiyananthan & P. Kumar Controlled Trial at Tertiary Referral Hospitals in an Asia Pacific Country Lai Poh Soon, Mohamad Helmee Stature Estimation of The Malaysian Population Egyptian Journal of forensic Radiology 0.36 Mohamad Noor, Nurliza Abdullah Based on Sacrum CT Scans Science Forensic Pattern of Antibiotic Prophylaxis Practice for Dental Journal of Indian Society of Jama'iah Mohd Sharif, Raja Zarina Raja Procedures in Children with Pedodontics and Preventive 0.28 Paediatric Shahardin, Ganasalingam Sockalingam Congenital Heart Disease Dentistry Hishamshah Mohd Ibrahim, Zulaiha Observational Study on The Current Status of Muda, Ida Shahnaz Othman, Mohamed Thalassaemia in Malaysia: A Report from the BMJ Open 1.25 Paediatric Najib Mohamed Unni, Kok Hoi Malaysian Thalassaemia Registry Teh, Asohan Thevarajah Paediatric Uday Y H Abdullah, Hishamshah brahim, Genotype-Phenotype Correlation of Β-Thalassemia Haematology Noraesah Binti Mahmud, Mohamad Zaki in Malaysian Population: Toward Effective Genetic Haemoglobin 0.36 Oncology Salleh, Lay Kek Teh, Counseling Pathology Dyskinesia is Most Centrally Situated in an Estimated Shih-Ku Lin, Sandeep Grover, Network of Extrapyramidal Syndrome in Asian Roy Abraham Kallivayalil, Patients with Schizophrenia: Findings from Research Nordic journal of psychiatry 0.72 Neurology Kok Yoon Chee on Asian Psychotropic Prescription Patterns for Antipsychotics Chow Xiao Hong, Jeyasakthy Saniasiaya, Paediatrics And Family Rare Manifestation of Pott's Spine ENT Iskandar Hailani Medicine Poland Abdul Rashida, M.K. Singhb, S.S. Feng, Lethal Morel-Lavallée Lesion: A Forensic Radiology Case Report 0.21 Forensic N. Mohd Yatim, M.Y. Sahak, R. Mahmud Radiology-Pathology Correlation Wan Azman Wan Sulaiman, Arman Plastic and Blue Rubber Bleb Nevus Syndrome in A Malay Girl: International Journal of Zaharil Mat Saad, Normala Basiron, Nik 0.23 Reconstructive A Case Report and Literature Review Surgery Case Reports Amin Sahid Surgery Long-Term Safety and Efficacy of N8-GP in Previously Journal of Thrombosis and Pusat Darah Faraizah Abdul Karim Treated Adults and Adolescents with Hemophilia A: 1.93 Haemostasis Negara Final Results from Pathfinder2 Minimal Agreement Between Basophil Activation F. Bakhtiara, M.M. Tang, Z.H.M. Yadzira, Allergologia et Test and Immunoassay in Diagnosis of Penicillin 0.37 Dermatology N. Abdullaha Immunopathologia Allergy Harikrishna K R Nair, Nazni Wasi International Journal of Ahmad, Chien Huey Teh, Han Lim Maggot Debridement Therapy in Malaysia 0.39 Medical Lower Extremity Wounds Lee, Sylvia Syin Ying Chong Lay See Khoo, Ahmad Hafizam Management of The Dead During COVID-19 Forensic Science, Medicine, Hasmi , Mohamad Azaini 0.55 Forensic Outbreak in Malaysia and Pathology Ibrahim , Mohd Shah Mahmood Chow Xiao Hong, Nur Aida Razuan, Azila Zygomatic Root Abscess: A Rare Entity Not to Be Auris Nasus Larynx 0.73 ENT Alias, Farah Hani Hassan, Zara Nasseri Forgotten! Ahmad Hafizam Hasmi, Lay See Khoo, Zhao Peng Koo, Muhammad Uzair The Craniotomy Box: An innovative Method of Ahmad Suriani, Ain Nurfarahana Forensic Science, Medicine, Containing Hazardous Aerosols Generated During 0.55 Forensic Hamdan, Siti Wira Md Yaro, Salmah and Pathology Skull Saw Use in Autopsy on A COVID-19 Body Arshad, Sheue Feng Siew, Mohamad Azaini Ibrahim, Mohd Shah Mahmood Muhammad Ariff M.Y, Dzulkarnain Amir, International Journal of Epidural Haematoma in a Child: A Case Report 7.583 Orthopedic Fazir Mohamad, Mohd Fareez O Science and Research

Lai Poh Soon, Mohd Helmee M.N., Original Article: Pelvic Morphometric Analysis Based International Journal of 1.619 Forensic Nurliza Abdullah on Sex and Ancestry Among Malaysian Population Forensic Science

Distribution of Anterolateral Thigh Flap Perforator Plastic and Mohammad Ali Mat Zain, Archives of Hand and Vessels and Its Clinical Applications in Malaysian - Reconstructive Normala Basiron Microsurgery Population Surgery

PAGE 39 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [JULY]

Impact Author Research Title Journal Department Factor Association of Dietary Patterns with Serum Karuthan Chinna, Abdul Halim Phosphorus in Maintenance Haemodialysis Scientific Reports 1.34 Nephrology Abdul Gafor, Sunita Bavanandan Patients: A Cross-Sectional Study Uniportal Video Assisted Thoracoscopic Surgery Nguk Chai Diong, Benedict Dharmaraj, Right Upper Sleeve Lobectomy- The First Medical Journal of Malaysia 0.23 Surgery Narasimman Sathiamurthy Experience in Hospital Kuala Lumpur Early B-Cell Factor 3-Related Genetic Disease Can Keng W Teik, Sangeet Sidhu Kidney International Reports 1.19 Genetic Mimic Urofacial Syndrome Aplasia Cutis Congenita as a Sole Manifestation of Kin Fon Leong Case Reports in Pediatrics - Paediatric Congenital Varicella Syndromes Serology Surveillance of Anti-SARS-Cov-2 Yuan Liang Woon, Yee Leng Lee, Antibodies Among Asymptomatic Healthcare Medical Yoong Min Chong, Nor Aliya Ayub, Research Square - Preprint - Workers in Malaysian Healthcare Facilities CRC HKL Raj Kumar Sevalingam, Azura Ramli, Designated for COVID-19 Care Siaw Yen Ong, Min Moon Tang, Izzaty Human Immunodeficiency Virus-infected Men Dalawi, Wooi Chiang Tan, Chin Aun Who Have Sex with Men with Syphilis: A 5-Year Medical Journal of Malaysia 0.23 Dermatology Yeoh, Wee Meng Kho Multicentre Study in Malaysia Proximal Curve Decompensation Following a Local Wan Zainuddin WAR, Dzulkarnain Amir, International Journal of Resection and Selective Fusion of Lumbar Spine 7.583 Orthopedic Fazir Mohamad Science and Research Osteoblastoma with Scolosis: A Case Report Kin Fon Leong Tinea Corporis: An Updated Review Drugs in Context 0.85 Paediatric Syahir Hassan , Md Arad Jelon, Nur Fast and Economical Protocol for In-House Virtual Journal of 3D Printing in Oral Maxillofacial Ikram Hanim Abd Rahim, Mohammad Planning and 3D-Printed Surgical Templates in - Medicine Surgery Adzwin Yahya & Norhayati Omar Mandibular Reconstruction Amy O, Kalaiselvi, Anusha, Surgical Excision of Dumb Bell-Shaped Vagal International Medical Journal 0.14 ENT Zakinah Yahaya Schwannoma Malaysia Nijar Mohd Lutfi, Ye Yun Phang Challenges Faced During The Ventilation of A Child Fakir Mohamed Intan Zarina, ismail Anesthesia & Analgesia 1.41 Anaesthesiology with Bronchobiliary Fistula: A Case Report Hamidah, Ali Saedah Cherh Yun Teoh, Adliah Mhd. Ali, Self-Perceived Competence and Training Needs Noraida Mohamed Shah, Analysis on Antimicrobial Stewardship Among JAC-Antimicrobial Resistance - Pharmacy Rohana Hassan, Chee Lan Lau Government Ward Pharmacists in Malaysia Cryobiopsy in the Diagnosis of Bronchiolitis a Syakirin Sirol Afah Syazatul Retrospective Analysis of Twenty Three Scientific Reports 1.34 IPR Consecutive Patients Chai Har Loo, Alex Cheen Hoe Khoo, The Findings of 18F-Fluorodeoxyglucose Positron Wooi Chiang Tan, Yek Huan Khor, Jyh Emission Tomography–Computed Tomography World Journal of Nuclear - Dermatology Jong Tang, Min Moon Tang, Lee Chin Scan in Patients with Hidradenitis Suppurativa in Medicine Chan Malaysia: A Multicenter Study Ammar Muizzuddin Manas, Mohd Yazid Giant Glomus Tumour of The Forearm - Journal of Clinical & 0.29 Orthopedic Bajuri, Suryasmi Duski, Chye Ping Ching An Unusual Occurrence Diagnostic Research Knowledge and Attitudes of Healthcare Wei Loon Oo, Nirmala Devi Baskaran, Professionals and The Impact on Willingness to Singapore Medical Journal 0.45 Nephrology Hasdy Haron, Raghu Varadarajan Donate Organs: A Tertiary Hospital Survey Management of Idiopathic CNS Inflammatory Diseases During The COVID-19 Pandemic: Multiple Sclerosis and Shanthi Viswanathan Perspectives and Strategies for Continuity of Care 0.83 Neurology Related Disorder from A South East Asian Center with Limited Resources RANBP2 Susceptibility to Infection-Induced Molecular Genetics and H.B. Chew, L.H. Ngu Encephalopathy: Clinicoradiologic and Molecular 0.51 Genetic Metabolism Reports Description in a Malaysian Family Muhammad Aminuddin Ashari, Isa Strategies for Radiology Departments in Handling Diagnostic and 0.65 Radiology Azzaki Zainal, Faizah Mohd Zaki The COVID-19 Pandemic Interventional Radiology Video Narratives Intervention Among Stroke Jamuna Rani Appalasamy, Joyce Pauline Survivors: Feasibility and Acceptability Study of a JMIR aging - Neurology Joseph, Siva Seeta Ramaiah Randomized Controlled Trial Indian Journal of Rachel Lim, Tze Liang Loh, Zakinah Fourth Branchial Pouch Sinus - A Rare, Often Otolaryngology, Head & 0.32 ENT Yahaya, Aneeza Wan Hamizan Misdiagnosed Congenital Anomaly Neck Surgery Chow Xiao Hong, Asma Abdullah, Azila Otological Manifestations of Langerhans Cell Indian Journal of Otology 0.19 ENT Alias, Suriyati Mohd Yusoff Histiocytosis In A Child - An Enigma That Persists! PAGE 40 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [AUGUST]

Impact Author Research Title Journal Department Factor Narasimman Sathiamurthy Aerosol-Generating Procedures in Thoracic Asian Cardiovascular and Narendran Balasubbiah, Benedict 0.2 Surgery Surgery in The COVID-19 Era in Malaysia Thoracic Annals Dharmaraj Nava Yugavathy, Hasniza Zaman Clinical and Genetic Markers of Huri, Lim Soo Kun, Abdul Halim Bin Erythropoietin Deficiency Anemia in Chronic 0.67 Nephrology Abdul Gafor, Wong Muh Geot, Biomarkers in Medicine Kidney Disease (Predialysis) Patients Sunita Bavanandan, Wong Hing Seng Changes in Serum Perampanel Concentration Sumitha Murugesu Profile After Discontinuation of Epileptic Disorders 0.68 Paediatric Carbamazepine Elaine Kan, Suzana Mustafa, Wei Relationship Between Adherence to Opioid Wen Chong, Chandini Menon Analgesics and Pain Beliefs Among Patients Patient Preference and 0.79 Pharmacy Premakumar, Noraida Mohamed with Cancer Pain at Tertiary Care Hospitals in Adherence Shah Malaysia Quality of Working Life and Career Siti Raba’ah Hamzah, Siti Nur Engagement of Cancer Survivors: The European Journal of Syuhda Musa, Zulaiha Muda, 0.38 Oncology Mediating Role of Effect of Disease and Training and Development Maimunah ismail Treatment Tay Poh Sen, Noor Aida Mat Daud, Cranial Polyneuropathy Caused by Journal of Cardiovascular, - Radiology Hilwati Hashim Vertebrobasilar Dolichoectasia Neurovascular & Stroke Benedict Dharmaraj, Nguk Chai Diong, Navindra Shamugam, Surgery, Chest Wall Resection and Reconstruction: Indian Journal of Thoracic Narasimman Sathiamurthy, Plastic and A Case Series of 20 Patients in Hospital Kuala and Cardiovascular 0.11 Hamidah Mohd Zainal, Siew Cheng Reconstructive Lumpur, Malaysia Surgery Chai, Khai Luen Koh, Mohammad Ali Surgery Mat Zain, Normala Haji Basiron Norlinah Mohamed Ibrahim, Yue Hui Lau, Noorasyikin Ariffin, Siti Hajar Md Frequency of Spinocerebellar Ataxia Type 1, Desa, Elena Azizan, Long Kha Chin, 2, 3,6 and 7 and Clinical Profile of Cerebellum & Ataxias 1.1 Neurology Shahrul Azmin Md Rani, Yusnita Spinocerebellar Ataxia Type 3 in Malaysia Yakob, Santhi Datuk Puvanarajah Sarah Abdul Karim, Sarah Shaikh , Fariza Anis Md, Umul Khair Experience Repatriation of Citizens from Mohamad ,Marlina Abu Bakar, International Journal of Epicentre using Commercial Flights During 0.48 Emergency Khairul Nizam Mohamad, Maria Emergency Medicine Covid-19 Pandemic Suleiman, Hussein Omar Khan, Julina Md Noor Mohammed Harris bin Anwarali Death of Bipolar Hemiarthroplasty Meeting International Journal of 7.583 Orthopedic Khan Patient Expectation Science and Research 99m Tc-Sodium Phytate is A Valid Alternative to The Gold-Standard 99m Tc-Sulfur Colloid Norazlina Mat Nawi, Nashrulhaq in The Measurement of Gastric Emptying Nuclear Tagiling, Mohd Fazrin Mohd Rohani, BMC Gastroenterology 0.96 Among Healthy Multi-Ethnic Asian Medicine Wan Mohd Nazlee Population: Results of A Randomized Cross-Over Trial Relationship Between Body Mass Index and Extrapyramidal Symptoms in Asian Patients Kok Yoon Chee with Schizophrenia: The Research on Asian Psychiatria Danubina 0.35 Psychiatry Psychotropic Prescription Patterns for Antipsychotics (REAP-AP) Medical-Grade Honey Kills Antibiotic- Resistant Bacteria and Prevents Amputation Harikrishna K. R. Nair Antibiotics 1.17 Medical in Diabetics with Infected Ulcers: A Prospective Case Series

PAGE 41 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [AUGUST]

Impact Author Research Title Journal Department Factor Harikrishna K R Nair, Nazni Wasi

Ahmad, Han Lim Lee, Norazah The International Journal Ahmad, Suhana Othamn, Noor Hirudotherapy in Wound Healing 0.39 Medical of Lower Extremity Shazleen Husnie Mohd Mokhtar, Wounds Sylvia Syin Ying Chong Extensive Aplasia Cutis Congenita Encircling Kin Fon Leong Case Reports in Pediatrics - Paediatric The Trunk Associated with Fetus Papyraceus S Viswanathan, Nevein P Botross, Gaik B Eow, Yen T Chin, Association between Appendectomy and Ruban Kanesalingam, Demyelinating Disorders in Subjects 40 Years Neurology India 0.35 Neurology Mohamed A R Isman, Jia M and Older Cheang, Rusli Bin Nordin, Suneet Sood Clinical Efficacy and Safety of Single Cycle Tien Lee Ong, Rituximab as Induction Therapy for Neuroimmunology and Shanthi Viswanathan, Sheila Aggressive Neuromyelitis Optica Spectrum 1.67 Neurology Neuroinflammation Ong, Fu Liong Hiew Disorder in A Resource Limited Center: A Preliminary Study Sunita Bavanandan, Wan Shakira Prevalence of Chronic Kidney Disease and its Rodzlan Hasani, Ghazali Ahmad, Associated Factors in Malaysia; Findings BMC Nephrology 0.79 Nephrology Rashidah Ambak, Fatimah Othman, From a Nationwide Population-Based Hamizatul Akmal Abd Hamid Cross-Sectional Study Application of Facial Recognition Technology Khoo Lay See, Mohd Shah Forensic Science on Identification of The Dead During Large 0.87 Forensic Mahmood International Scale Disasters Ai Huey Tan, Katja Lohmann, Yi Wen Tay, Jia Lun Lim, Azlina Ahmad PINK1 P.Leu347Pro Mutations in Malays: Parkinsonism and Related Annuar, Norlisah Ramli, Yen Theng 1.48 Neurology Prevalence and Illustrative Cases Disorder Chin, Ahmad Shahir Mawardi, Santhi Datuk Puvanarajah Study Protocol for A Double-Blind, Mohamad Shariff A Hamid, Kamarul Randomised Placebo-Controlled Trial Hashimy Hussein, Ahmad Evaluating Clinical Effects of Platelet-Rich Munawwar Helmi Salim, Arshad BMJ Open 1.25 Orthopedic Plasma Injection for Acute Grade-2 Puji, Chin Chee Yong, Thomas Wong Hamstring Tear Among High Performance Yong Sheng Athletes Osman Adi, Kok Meng Sum, Azma Novel Role of Focused Airway Ultrasound in Haryaty Ahmad, Mahathar Abd Early Airway Assessment of Suspected Ultrasound Journal 0.63 Emergency Wahab, Luca Neri, Nova Panebianco Laryngeal Trauma Munirah ismail, Kun Yun Lee, Afandy The Prevalence of Psychological Distress and Sutrisno Tanjung, Ida Anum Ahmad its Association with Coping Strategies Among Jelani, Rabiah Abdul Latiff, 0.46 Psychiatry Medical Interns in Malaysia: A National-Level Asia-Pacific Psychiatry Hashimah Abdul Razak, Nor Izzah Cross-Sectional Study Ahmad Shauki Norlinah Mohamed Ibrahim, Yue Hui Lau, Noorasyikin Ariffin, Siti Frequency of Spinocerebellar Ataxia Type 1, Hajar Md Desa, Elena Azizan, Long 2, 3,6 and 7 and Clinical Profile of Spino- 1.1 Neurology Kha Chin, Shahrul Azmin Md Rani, Cerebellum & Ataxias cerebellar Ataxia Type 3 in Malaysia Yusnita Yakob, Santhi Datuk Puvanarajah Recent Patents on Kin Fon Leong Nummular Eczema: An Updated Review Inflammation & Allergy 0.44 Paediatric Drug Discovery Jasmine Lim, Rohan Malek, Murali Modified J-CAPRA Scoring System in Sundram, Guan C Teh, Teng-Aik Predicting Treatment Outcomes of Ong, Shankaran Thevarajah, Rohana Cancer Medicine 1.32 Urology Metastatic Prostate Cancer Patients Zainal, Say C Khoo, Shamsuddin Undergoing Androgen Deprivation Therapy Omar, Noor A Nasuha PAGE 42 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [SEPTEMBER]

Impact Author Research Title Journal Department Factor Effect of Iterative Reconstruction Algorithm Levels H H Harun, M K A Karim, Z Abbas, A Journal of X-Ray Science and on Noise Index and Figure-of-merit in CT 0.35 Radiology Sabarudin, S C Muniandy, M J Ibahim Technology Pulmonary Angiography Examinations M.Arumugam, H.Sallehuddin & F.M.N Indian Journal of A Clinical Approach to Diagnosing Trigger Wrist 0.39 Orthopedic Rashdeen Orthopaedics Koebner’s Phenomenon in Psoriasis Post Nipple Y. L. Tan, R. A. Raflis , N. A. Hakim , E. N. Asian Journal of Case Reports Sparing Mastectomy with Immediate Silicone - Surgery Aina and A. Daphne in Surgery Implant Breast Reconstruction Hanif Haspi Harun, Muhammad Khalis Association of Radiation Doses and Cancer Risks Abdul Karim, Zulkifly Abbas, Mohd Amir from CT Pulmonary Angiography Examinations in Diagnostics 0.82 Radiology Abdul Rahman, Akmal Sabarudin, Kwan Relation to Body Diameter Hoong Ng Hanif Haspi Harun, Muhammad Khalis Establishment of CTPA Local Diagnostic Reference Abdul Karim, Mohd Amiruddin Abd Levels with Noise Magnitude as a Quality Indicator Diagnostics 0.82 Radiology Rahman, Hairil Rashmizal Abdul Razak, in a Tertiary Care Hospital Iza Nurzawani Che isa,Faeezah Harun The Impact of COVID-19 Pandemic on The Molecular Genetics and Lock-Hock Ngu Diagnosis and Management of Inborn Errors of 1.4 Genetic Metabolism Metabolism: A Global Perspective Li-Ping Wong, Yek-Ching Kong, Nanthini Thevi Bhoo-Pathy, Shridevi Breaking News of Cancer Diagnosis: A Qualitative Subramaniam, Ros Suzanna Bustamam, Study on The Experiences and Emotional Needs of JCO Oncology Practice - Oncology Nur Aishah Taib, Gwo-Fuang Ho, Hafizah Patients with Cancer in A Multiethnic Asian Setting Zaharah, Matin Mellor, Yin-Ling Woo, Cheng-Har Yip, Nirmala Bhoo-Pathy Kin Fon Leong Pityriasis Rosea: An Updated Review Current Pediatric Reviews 0.36 Paediatric Self-Perceived Disease Control in Childhood Journal of Dermatological Kin Fon Leong 0.82 Paediatric Eczema Treatment

Kushilpal Kaur, Ahmad Hatim Sulaiman, Elucidating Mental Health Disorders among International Journal of 0.74 Psychiatry Chee Kok Yoon, Aili Hanim Hashim, Rohingya Refugees: A Malaysian Perspective Environmental Research and Public Health Kin Fon Leong Pityriasis Rosea: An Updated Review Current Pediatric Reviews 0.36 Paediatric Nava Yugavathy , Hasniza Zaman Huri, Clinical and Genetic Markers of Erythropoietin Lim Soo Kun, Abdul Halim Bin Abdul Deficiency Anemia in Chronic Kidney Disease Biomarkers in Medicine 0.67 Nephrology Gafor, Wong Muh Geot, Sunita (Predialysis) Patients Bavanandan, Wong Hing Seng Our Experience with Emergency Ophthalmic Shu Yee Seow, Sabrina Abu Hassan Malaysian Journal of Surgery at Hospital Kuala Lumpur During the - Ophthalmology Asaari, Jamalia Rahmat Ophthalmology COVID-19 Pandemic Li-Ping Wong, Yek-Ching Kong, Nanthini Breaking News of Cancer Diagnosis: A Qualitative Thevi Bhoo-Pathy, Shridevi Study on the Experiences and Emotional Needs of JCO Oncology Practice - Oncology Subramaniam, Ros Suzanna Bustamam Patients With Cancer in A Multiethnic Asian Setting Kin Fon Leong A Neonate With Hemihyperplasia Pediatrics Consultant - Paediatric Hock Leng Lee, Min Moon Tang, Sensitization to Local Seafood Allergens in Adult Mohammed Faizal Bakhtiar, Zailatul Hani International Archives of 0.97 Dermatology Patients with Atopic Dermatitis in Malaysia Mohamad Yadzir, Asmah Johar Allergy and Immunology A Novel ITPA Variant Causes Epileptic Muzhirah Haniffa Journal of Human Genetics 1.39 Genetic Encephalopathy with Multiple-Organ Dysfunction Variant Chee Nee Vern, Zayani Zohari, Red Herring Unmasked: The Trail Leading to Malaysian Journal of - Ophthalmology Chan Li Yen, Jamalia Rahmat Retinoblastoma Ophthalmology

Variant Chee Nee Vern, Zayani Zohari, Neonatal Retinoblastoma: A Brief Report From the Malaysian Journal of _ Ophthalmology Chan Li Yen, Jamalia Rahmat Malaysian Retinoblastoma Registry Ophthalmology Kin Fon Leong A Case of Infantile Hemangioma Pediatrics Consultant - Paediatric Ng Bee Zhen, Ng Chong Guan, Sapini Malaysian Journal of Lithium-induced Nephrogenic Diabetes Insipidus - Psychiatry Yacob Psychiatry The Outcome of Three-factor Prothrombin Hock Peng Koh, Nirmala Jagan, Szu Lynn Complex Concentrate (3F-PCC) in Warfarin Tay, Jivanraj Nagarajah, Noel Thomas Thrombosis Update - Pharmacy Reversal: A single Center Retrospective Cohort Ross Study PAGE 43 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [OCTOBER]

Impact Author Research Title Journal Department Factor Shridevi Subramaniam, Ros Suzanna Working After Cancer: In-Depth Perspectives Bustamam, Li-Ping Wong, Gwo-Fuang Journal of Cancer Oncology and From a Setting with Limited Employment Protec- 1.61 Ho, Hafizah Zaharah, Matin Mellor, Survivorship Radiotherapy tion Policies Cheng-Har Yip, Nirmala Bhoo-Pathy Rema Panickar, Wee Kee Wo, Norleen M Allopurinol-Induced Severe Cutaneous Adverse Pharmacoepidemiology and Ali, Min Moon Tang, G R Letchuman Drug Reactions: Risk Minimization Measures in 1.22 Dermatology Drug Safety Ramanathan Malaysia Retained Haemodialysis-Catheter Guidewire in Chow Xiao Hong, Syafazaima Abd The Head and Neck: A Multidisciplinary Team BMJ Case Reports 0.2 ENT Wahab, Mawaddah Azman Approach Cutis Marmorata Telangiectatica Congenita Kin Fon Leong Case Reports in Pediatrics - Paediatric Associated with Hemiatrophy International Journal of Mansharan Kaur Chainchel Singh, Sheue Isolated Hyoid Bone Fracture in A Child due to a Pediatric 0.67 Forensic Feng Siew, Poh Soon Lai Fall Otorhinolaryngology Zhenli Kwan, Nurakmal Baharum, Shin Sexual Difficulties and Associated Factors Among Psychology, Health & Shen Yong, Azura Mohd Affandi, Asmah Patients with Psoriasis in Malaysia: Data from 0.66 Dermatology Medicine Johar the Malaysian Psoriasis Registry Traumatic Brain Injury Outcomes in 10 Asian Maznisah Mahmood, Chin Seng Gan, Pediatric Critical Care Pediatric ICUs: A Pediatric Acute and Critical Care 1.21 Paediatric Olive P E Lee, Medicine Medicine Asian Network Retrospective Study Sequential Intermittent Therapeutic Plasma Shanthi Viswanathan, Jie Ping Schee, Exchange: A Possible Induction and Maintenance Therapeutic Apheresis and 0.37 Neurology Mohd Azahadi Omar, Fu Liong Hiew Therapy in The Management of Adult Patients Dialysis with Neuromyelitis Optica Spectrum Disorder Exploring Patients’ Experience on Hospital Rui Jie Ng, Nik Nur Eliza Mohamed, Ili Pertanika Journal of Social Merger: Have They benefited from Cluster 0.17 CRC HKL Liyana Khairul Anuar, Kun Yun Lee Science and Humanities Hospital Initiative in Malaysia? Sarah Shaikh Abdul Karim, Fariza Anis Experience Repatriation of Citizens from Epicen- International Journal of Md Tahir, Umul Khair Mohamad, tre using Commercial Flights during COVID-19 0.48 Emergency Emergency Medicine Marlina Abu Bakar Pandemic An Evaluation of The Video Narrative Technique Jamuna Rani Appalasamy, Kia Fatt Quek, on The Self-Efficacy of Medication Understand- Patient Preference and Anuar Zaini Md Zain, Joyce Pauline 0.79 Neurology ing and Use Among Post-Stroke Patients: Adherence Joseph A Randomized-Controlled Trial Development and Validation of A Rizal Husaini Razali, Mohd Salleh Rofiee, High-Performance Liquid Chromatography– Journal of Analytical Lay Kek Teh, Kok Hoi Teh, Hishamshah 0.26 Paediatric Tandem Mass Spectrometry Method for Metho- Chemistry Mohd Ibrahim & Mohd Zaki Salleh trexate Quantitation in Human Serum Quality of Life, Hospitalisation and Sarcopenia Journal of Gerontology and Adha Nawawi, Rizah Mazzuin Razali Among The Elderly: A Systematic Review 0.18 Medical Geriatrics

Benedict Dharmaraj , Narasimman Primary Lung Carcinoma with Tracheal Bronchus Sathiamurthy , Nguk Chai Diong , Treated with Uniportal Video-Assisted Mini Invasive Surgery 0.4 Surgery Narendran Balasubbiah Thoracoscopic Upper Lobectomy: A Case Report Pathology Norliyana, N., D Nurzam, S.C.H., A Fatal Case of Primary Melioidotic Prostatic Tropical Biomedicine 0.23 Urology Salbiah, N. and Rao, K.R. Abscess: The Peril of Poor Drug Compliance Medical Mansharan Kaur C.S., Lai Poh Soon, Original Article: Isolated Hyoid Bone Fracture in International Journal of 1.241 Forensic Siew Sheue Feng Child Due to A Fall Paediatrics Otolaryngology Case Report: There's always a Tomorrow and International Journal of Mohammed Harris bin Anwarali Khan The Hope of Something New- Revision Aseptic 7.583 Orthopedic Science and Research Loosening Bipolar Hemiarthroplasty Diagnostic Procedures & Practices in Drug Min-Moon Tang, Jie Shen Fok,Bernard Allergy/Hypersensitivity: A Survey of 13 Asian Asia Pacific Allergy 0.33 Dermatology Yu-Hor Thong, James Yun Countries Modified J-CAPRA Scoring System in Predicting Treatment Outcomes of Metastatic Prostate Rohan Malek, Murali Sundram Cancer Medicine 1.32 Urology Cancer Patients Undergoing Androgen Depriva- tion Therapy Diagnostic Performance of The STOP-Bang Su Yin Loo,Carmen K.M. Lam,David S. Journal of Clinical Sleep Med- Questionnaire As A Screening Tool For Obstruc- 1.15 Anaesthesiology Hui, Frances Chung icine tive Sleep Apnea in Different Ethnic Groups PAGE 44 CRCHKL E-NEWSLETTER ISSUE 7 2020 PUBLICATION BY HKL STAFF 2020 [NOVEMBER]

Impact Author Research Title Journal Department Factor Efficient Detection of Copy-number Variations Lock-Hock Ngu Human Mutation 2.41 Genetic using Exome Data: Batch- and Sex-based Analyses Asian Pacific Society of Nephrology Clinical Sunita Bavanandan, Soo Kun Lim Practice Guideline on Diabetic Kidney Disease - Nephrology 0.59 Nephrology An Executive Summary De Novo Variants in CELF2 That Disrupt The Kato Winnie Peitee Ong Hui Bein Chew Nuclear Localization Signal Cause Developmental Human Mutation 2.41 Genetics Kavitha Rethanavelu and Epileptic Encephalopathy

Umi Adzlin Silim, Noor Izuana Redzuan, Mental Health Status of Stable Hospitalized Psychiatry, CRC Adlin Mohd Salleh, Hariani Ishak, Salina COVID19 Patients in the Main COVID-19 Hospitals Research Square (Pre-print) - HKL Abdul Aziz, Loi Fei Chin in Malaysia

Assessing Adherence and Persistence to Mazlan-Kepli, Nirmala Jagan, Sahimi Non-Vitamin K Antagonist Oral Anticoagulants Journal of Pharmacy & 0.3 Pharmacy Mohamed (NOACS) Among Patients with Atrial Fibrillation in Bioallied Sciences Tertiary-Care Referral Centers in Malaysia

Rurioctocog Alfa Pegol PK-guided Prophylaxis in Oleksandra Stasyshyn, Hishamshah Hemophilia A: Results from The Phase 3 PROPEL Blood 5.42 Pediatric Mohd Ibrahim Study Technology Perception and Productivity Among Poh Ye Han Physicians in The New Norm Post Pandemic : Springer Publication - Anaesthesiology A Dynamic Capabilities Perspective Chan Gin Peng, Tang Min Moon, Adult Onset Still’s Disease: A Case Report in Malaysian Journal of - Dermatology Suganthi Thevarajah Hospital Kuala Lumpur Dermatology

Rafiq Shahadan , Goh Siew Wen, Basal Cell Carcinoma in The Department of Malaysian Journal of - Dermatology Azura Mohd Affandi Dermatology, Hospital Kuala Lumpur, Malaysia Dermatology

Original Article: Durability of Cling Film Plastic Forensic Science Lay See Khoo, Mohd Shah Mahmood Wrap Usage Towards Human Decomposition 0.3 Forensic International: Synergy Changes Mohd Fazrin Mohd Rohani, Ahmad Zaid Zanial, Subapriya Suppiah, Khor Phay Bone SPECT-CT in Cancer Care in the Past Decade: Nuclear Medicine Phay, Farahnaz Mohamed Aslum Khan, A Systematic Review and Meta-Analysis as well as 1.334 Nuclear Medicine Communications Fatin Hayyani Mohamad Najib, Siti Recommendations for Further Work Zarina Amir Hassan Radioactive Injections for Chronic Swollen Legs: Malaysian Journal of Medical Ahmad Zaid Zanial - Nuclear Medicine Case Series of Bilateral Lymphoedema Research Amanda A Lavinya, Ruzzieatul A Razali, Homozygous Southeast Asian Ovalocytosis in Five Munirah A Razak, Rashidah Mohamed, Haematologica 2.93 Pathology Live-Born neonates Emmanuel J Moses Optimal Mean Corpuscular Haemoglobin (MCH) Malaysian Journal of Faridah Idris, Chiu Yee Liew, Zainina Cut-Off Value for Differentiating Alpha Plus and Medicine and Health 0.12 Pathology Seman, Noraesah Mahmud Alpha Zero Thalassaemia in Thalassaemia Sciences Screening Nadzrin Md Yusof, Noraini Mohd Dusa, Malaysian Journal of Superficial Angiomyxoma of the Eyelid. A Case Norhafizah Mohtarrudin, Razana Mohd Medicine and Health 0.12 Pathology Report and Review of the Literature Ali Sciences Boey Ching Yeen, Mohamed Aslum Giant Liver Hemangioma Mimicking a Khan, Farahnaz FANMB, Amir Hassan, Hydronephrotic Kidney on 99mTc-DTPA Clinical Nuclear Medicine 0.58 Nuclear Medicine Siti Zarina Scintigraphy

Shaiful Azlan, Noor Ani Ahmad, Umi A Study Protocol on Methodological Approach in Adzlin Silim, Najib Abdullah, Norazam Mental Health Status of COVID-19 Patients in the Research square - Psychiatry Harun, Muhammad Solihin Rezali, Ying Main Hospitals in Malaysia (MentalStatCOVID) Ying Chan, Norhazah Sahril

PAGE 45 CRCHKL E-NEWSLETTER ISSUE 7 2020 TRAINING ACTIVITIES

Orthopedic Interdepartmental Training : Introduction to NMRR & Literature Search (Pubmed) 28 January 2020, Dewan Dato’ Borhan, HKL.

Orthopedic Interdepartmental Training : Research Methodology 28 February 2020, Dewan Dato’ Borhan, HKL.

PAGE 46 CRCHKL E-NEWSLETTER ISSUE 7 2020 TRAINING ACTIVITIES

Introduction to Clinical Research (ICR) 3 March 2020 : For Allied Healthcare Professionals 21 July 2020 : For Healthcare Professionals Seminar Room, Level 5, SCACC.

Good Clinical Practice Workshop 22-24 September 2020, Corus Hotel, Kuala Lumpur.

PAGE 47 CRCHKL E-NEWSLETTER ISSUE 7 2020 TRAINING ACTIVITIES

Research Methodology Workshop 17 & 18 August 2020, National Transplant Resource Centre, Wisma Sejarah.

Manuscript Writing Workshop 30 September & 1 October 2020, National Transplant Resource Centre, Wisma Sejarah.

PAGE 48 CRCHKL E-NEWSLETTER ISSUE 7 2020 UPCOMING COURSES BY CRCHKL

All our courses will be advertised via Facebook or flyers to departments, so do follow our Facebook PAGEPAGE 4947 CRCHKL E-NEWSLETTER ISSUE 7 2020

WELCOME TO OUR NEW STAFF

DR. PREM A/L W.P VENUGOPAL Has joined CRC HKL since July 2020.

DR. VARAALAKSHMY A/P GOKILAVANAN Has joined CRC HKL since September 2020.

FAREWELL TO OUR FRIENDS

DR. SIVANESEN A/L ANTHONIDASS Working period: 20 June 2018 — 24 July 2020 He is a kind, easy going and a great team player. He left CRC to pursue others interests. We wish Dr Siva all the best in his future endeavour.

DR. NURDIANA MOHAMMAD HUSSIN Working period: 6 August 2019 — 30 November 2020 She is a soft spoken person, but firm in her decision. She is currently working at Quality Assurance Unit due to her qualification as a holder of the Master of Hospital Administration.

PAGE 50 CRCHKL E-NEWSLETTER ISSUE 7 2020

REFERENCES

Bernama. (9th October 2020). New Straits Time: Health DG: Malaysia Fernandes, N., (2020) Economic Effects of Coronavirus Outbreak entering 3rd wave of Covid-19 pandemic. Retrieved from (COVID-19) on the World Economy, IESE Business School Working https://www.nst.com.my/news/nation/2020/10/630761/health-dg- Paper No. WP-1240-E. Retrieved from SSRN: malaysia-entering-3rd-wave covid-19-pandemic https://ssrn.com/abstract=3557504 or http://dx.doi.org/10.2139/ssr n.3557504 British Broadcasting Corporation, 2020. Moderna: Covid vaccine shows nearly 95% protection. https://www.bbc.com/news/health- Fitzgerald, D.A., Nunn, K., Isaacs, D., (2020), Consequences of physi- 54902908 © 2020 BBC. Accessed 20 November 2020 cal distancing emanating from the COVID-19 pandemic: An Australi- an perspective, Paediatric Respiratory Reviews Volume Canady, V.A. (2020), APA poll finds nearly half anxious about getting 35, September 2020, Pages 25-30. COVID-19. Wileyonlinelibrary, Mental Health Weekly, 30: 5-5. https://doi.org/10.1016/j.prrv.2020.06.005 doi:10.1002/mhw.32295. Flanders Trade. (23 November 2020). CORONA VIRUS:The situation Centres for Disease Control and Prevention, 2020. Vaccine Testing in Malaysia. Retrieved from and the ApprovalProcess. https://www.cdc.gov/vaccines/basics/test- https://www.flandersinvestmentandtrade.com/export/nieuws/coro approve.html © U.S. Department of Health & Human Services, Cen- na-virus %E2%80%93-situation-malaysia tres for Disease Control and Prevention. Accessed 20 November 2020 Garis Panduan Pengurusan COVID 19 di Malaysia No.5. (2020). An- nex 3: Senarai Pusat Saringan dan Hospital Yang Mengendalikan Kes Chakraborty, I., Maity, P., (2020), COVID-19 outbreak: Migration, COVID-19. Retrived from effects on society, global environment and prevention, Science of http://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm the Total Environment 728 (2020) 138882. https://doi.org/10.1016/j.scitotenv.2020.138882 Garis Panduan Pengurusan COVID 19 di Malaysia No.5. (2020). An- nex 33: Mental Health and Psychosocial Support in COVID-19. Re- Cheng C. COVID-19 in Malaysia: economic impacts & fiscal re- trieved from http://covid-19.moh.gov.my/garis-panduan/garis pan- sponses. Institute of Strategic and International Studies (ISIS) Malay- duankkm/Annex_33_Mental_health_and_Psychosocial_support_230 sia; 2020 Retrieved from 32020.pdf https://www.isis.org.my/2020/03/26/covid-19-in- malaysiaeconomicimpactsfiscalresponses/ [Accessed 26 November Ghosal, S., Bhattacharyya, R., & Majumder, M. (2020). Impact of 2020]. complete lockdown on total infection and death rates: A hierarchical cluster analysis. Diabetes Metab Syndr, 14(4), 707-711. Chowdhury, R., Luhar, S., Khan, N., Choudhury, S. R., Matin, I., & doi:10.1016/j.dsx.2020.05.026 Franco, O. H. (2020). Long-term strategies to control COVID-19 in low and middle-income countries: an options overview of communi- IACT Health. Vaccine. ty-based, non-pharmacological interventions. Eur J Epidemiol, 35(8), https://iacthealth.com/vaccine/#:~:text=A%20vaccine%20is%20a%2 743-748. doi:10.1007/s10654-020-00660-1 0biological,one%20of20its%20surface%20proteins. Accessed 20 November 2020 Dawson L, Earl J, Livezey J; 2020. Severe Acute Respiratory Syndrome Coronavirus 2 Human Challenge Trials: Too Risky, Too Soon. J Infect Jamrozik E, Selgelid MJ; 2020. COVID-19 human challenge studies: Dis. 2020 Jul 6;222(3):514-516. ethical issues. Lancet Infect Dis. 2020 Aug;20(8):e198-e203.

Druss BG. Addressing the COVID19 Pandemic in Populations with Jianbo, L., Simeng,M., Ying,W., Zhongxiang,C., Jianbo,H., Ning,W., Serious Mental Illness. JAMA Psychiatry. 2020;77(9):891-892. Jiang,W., Hui,D., Tingting,C., Ruiting,L., Huawei,T., Lijun,K., Lihua,Y., doi:10.1001/jamapsychiatry.2020.0894 Manli,H., Huafen,W., Gaohua,W., Zhongchun,L., Shaohua,H., 2020. Factors associated with mental health outcomes among healthcare Dzulkifl,D., Muhyiddin,: tourism industry hit hardest by Covid-19, workers exposed to Corona virus Disease 2019. JAMA Netw faces RM3.37b loss. Malay Mail; 2020 Retrieved from Open. 2020;3(3):e203976. https://www.malaymail.com/news/malaysia/2020/03/13/muhyiddin doi:10.1001/jamanetworkopen.2020.3976 -tourism-industry-hit-hard-by-covid-19-tolose-rm3.37b-while-gdp- s/1846323 [Accessed 26 November 2020]. Kang, L.; Ma, S.; Chen, M.; Yang, J.; Wang, Y.; Li, R.; Yao, L., 2020, Impact on mental health and perceptions of psychological care Elengue, A. (2020). COVID-19 Outbreak in Malaysia. Osong Public among medical and nursing staff in Wuhan during the 2019 novel Health Res Perspect;11(3):93-100. coronavirus disease outbreak: A cross-sectional study. Brain. Brain, Doi : https://doi.org/10.24171/j.phrp.2020.11.3.08 behavior, and immunity.. 2020, 87, 11–17. https://doi.org/10.1016/ S2352-4642(20)30108-5 European Medicines Agency (EMA). 2020. Guidance on the manage- ment of clinical trials during the COVID-19 (coronavirus) pandemic. Khoo, L. S., Hasmi, A. H., Ibrahim, M. A., & Mahmood, M. S. (2020). https://ec.europa.eu/health/sites/health/files/files/eudralex/vol10/ Management of the dead during COVID-19 outbreak in Malaysia. guidanceclinicaltrials_covid19_en.pdf Forensic Sci Med Pathol, 16(3), 463-470. doi:10.1007/s12024-020-00269-6. Eyal N, Lipsitch M, Smith PG; 2020. Human Challenge Studies to Accelerate Coronavirus Vaccine Licensure. J Infect Dis. 2020 May 11;221(11):1752-1756.

PAGE 51 CRCHKL E-NEWSLETTER ISSUE 7 2020

Lazzerini,M., Barbi,E., Apicella, A., Marchetti, F., Cardinale, F., Trobia, G., 2020, Delayed access or provision of care in Italy resulting from Shah, A. U. M., Safri, S. N. A., Thevadas, R., Noordin, N. K., Rahman, fear of COVID-19. Lancet Child Adolescent Health 2020 A. A., Sekawi, Z., Sultan, M. T. H. (2020) COVID-19 outbreak in Ma- May;4(5):e10-e11.doi: 10.1016/S2352-4642(20)30108-5. laysia: Actions taken by the Malaysian government. International Journal of Infectious Diseases; 97:108-116. Lee, H. (2020) Implement emergency response to domestic violence doi:https://doi.org/10.1016/j.ijid.2020.05.093 amid COVID-19 crisis. Women’s Aid Organisation. Retrieved from: https://wao.org.my/implementemergency-response-to- Shakeel,S., Ahmed Hassali, M.A., Naqvi A.A., 2020, Health and eco- domesticviolence-amid-covid-19-crisis/ [Accessed 26 November nomic impact of COVID-19: mapping the consequences of a pan- 2020]. demic in Malaysia. Malays J Med Sci. 2020;27(2):159–164. https://doi.org/10.21315/mjms2020.27.2.16 Lorusso, D., Ray-Coquard, I., Oaknin, A., & Banerjee, A. (2020) Clini- cal research disruption in the post- COVID-19 era: will the pandemic Shanmugam,H., Juhari, J.A., Nair,P., Ken,C.S., Guan, N.C., 2020, Im- lead to change? ESMO Open, 5 (924). pacts of COVID-19 Pandemic on Mental Health in Malaysia: A Single doi:10.1136/ esmoopen-2020-000924 Thread of Hope, Malaysian Journal of Psychiatry, Vol 29, No 1 (2020) Lyn BS. (30 November 2020). Malaysia Only Has One Shot To End Covid-19. Retrieved from The Straits Times. (5th May 2020) PM Muhyiddin shares Malaysia’s https://codeblue.galencentre.org/2020/11/30/malaysia-only-has- sixpronged strategy in Covid-19 fight. Retrieved from one-shot-to-end-covid-19/ https://www.straitstimes.com/asia/se-asia/pm-muhyiddin-shares- malaysias-six-pronged-strategy-in-covid-19-fight Mackenzie JS, Smith DW. (2020) COVID-19—A Novel Zoonotic Dis- ease: A Review of the Disease, the Virus, and Public Health The World Health Organisation Coronavirus disease (WHO Solidarity Measures. Asia Pacific Journal of Public Health;32(4):145-153. Trial). (2020). “Solidarity” clinical trial for COVID-19 treatments. doi:10.1177/1010539520931326 https://www.who.int/emergencies/diseases/novel-coronavirus- 2019/global-research-on-novel-coronavirus-2019-ncov/solidarity- Majid, M. Covid-19: panic and the Malaysian economy. New Straits clinical-trial-for-covid-19-treatments Times; 2020 Retrieved from https://www.nst.com.my/opinion/columnists/2020/03/575187/covi The World Health Organisation News (WHO News). (2020). Malaysia d-19-panic-and-malaysian-economy [Accessed 26 November 2020]. starts global “Solidarity Trial” - a research effort to test possible treatments for COVID-19. Majlis Keselamatan Negara (MKN), (2020). Kenyataan Media Majlis https://www.who.int/malaysia/news/detail/05-04-2020-malaysia- Keselamatan Negara, Jabatan Perdana Menteri 18 Mac 2020. starts-global-solidarity-trial---a-research-effort-to-test-possible- https://asset.mkn.gov.my/web/wp- treatments-for-covid-19 content/uploads/sites/3/2020/03/PERGERAKAN-KAWALAN- COVID19-amended-18032020-UPDATED-12.12AM.pdf Umair, S., Waqas, U., Faheem, M. (2020) COVID-19 Pandemic: Strin- gent Measures of Malaysia and Implications for other Countries. Malaysia Guideline for Good Clinical Practice, 2018. 4th ed. Postgrad Medical Journal; 0:1-3. Doi: http://orcid.org/0000-0003- ©Ministry of Health Malaysia. 1207-9310

Medicines and Healthcare Products Regulatory Agency (MHRA). U.S. Food and Drug Administration (FDA). (2020) FDA guidance on (2020) Managing clinical trials during Coronavirus (COVID-19). conduct of clinical trials of medical products during COVID-19 public https://www.gov.uk/guidance/managing-clinical-trials-during- health emergency. U.S. Food and Drug Administration. coronavirus-covid-19 https://www.fda.gov/regulatory-information/search-fda-guidance- documents/fda-guidance-conduct-clinical-trials-medical-products- Minhat, H. S., & Kadir Shahar, H. (2020). The trajectory of COVID-19 during-covid-19-public-health-emergency scenario in Malaysia: facing the unprecedented. Curr Med Res Opin, 36(8), 1309-1311. doi:10.1080/03007995.2020.1786680. Van Dorn, A. (2020). COVID-19 and readjusting clinical trials. The Lancet, Vol 396, 523-524. Momtazmanesh, S., Ochs, H. D., Uddin, L. Q., Perc, M., Routes, J. M., Vieira, D. N., Rezaei, N. (2020). All together to Fight COVID-19. Am J Waleed,R., Sonia,M., Shamim,M., 2020. Mental health of medical Trop Med Hyg, 102(6), 1181-1183. doi:10.4269/ajtmh.20-028. workers in Pakistan during the pandemic COVID-19 outbreak. Asian Journal of Psychiatry,Volume 51, June 2020, 102080, Murugiah,S., Covid-19 to place Malaysian economy into technical https://doi.org/10.1016/j.ajp.2020.102080 recession, says AmBank. The Edge Markets; 2020 Retrieved from https://www.theedgemarkets.com/article/covid19-place-malaysian- Worldometer, 2020. COVID-19 Coronavirus Pandemic. economy-technical-recession-saysambank. https://www.worldometers.info/coronavirus/ ©Worldometers.info. [Accessed 26 November 2020] Accessed 26 November 2020

Rahman, F., (2020). The Malaysian Response to COVID-19: Building Wu YC, Chen CS, Chan YJ. (2020)The outbreak of COVID-19: An over- Preparedness for ‘Surge Capacity’, Testing Efficiency, and Contain- view, Journal of the Chinese Medical Association; 83(3 ): 217-220. ment. doi:https://kpkesihatan.com/2020/06/16/the-malaysian- doi: 10.1097/JCMA.0000000000000270 response-to-covid-19-building-preparedness-for-surge-capacity- testing-efficiency-and-containment/ Xiang, Y.T.; Yang, Y.; Li, W.; Zhang, L.; Zhang, Q.; Cheung, T.; Ng, C.H. Timely mental health care for the 2019 novel coronavirus outbreak Reger, M.A.; Stanley, I.H.; Joiner, T.E., 2020, Suicide mortality and is urgently needed. Lancet Psychiatry 2020, 7, 228–229. coronavirus disease 2019—A perfect storm? AMA Psychia- https://doi.org/10.1016/ S2215-0366(20)30046-8 try. 2020;77(11):1093-1094. doi:10.1001/jamapsychiatry.2020.1060

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