Asian Journal of Medicine and Biomedicine
The Asian Journal of Medicine and Biomedicine (AJMB) is an open access, free and double-blind peer-reviewed journal encompassing all scopes and areas of Medicine, Community Health, Medical Education, Health Sciences and Biomedicine. The journal provides immediate open access to its content on the principle that making research freely available to the public in order to support a greater global exchange of knowledge. AJMB is published by Universiti Sultan Zainal Abidin (UniSZA) and currently indexed in Google Scholar and MyCite. The Journal and its editorial team welcome the submission of manuscripts that meet the general criteria of significance and scientific excellence. In terms of language, AJMB only accepts manuscripts written in English language. Electronic submission of manuscripts is strongly encouraged, provided that the text, tables, and figures are included in a single Microsoft Word file (preferably in Arial font). e-AJMB publishes articles that focus on cutting-edge findings in the field mentioned above. AJMB also publishes case reports on different clinical findings, hence sharing not only knowledge but the experience of specialists and consultants in the related fields. Average Processing Time: The average processing time from receipt to acceptance for publication of an article is six months. Once a manuscript is accepted for publication, it will be uploaded as an early online edition of the e-AJMB. Processing charge: No charges applied. Publication schedule: April and October.
Phytochemical Screening and Evaluation of Antioxidant Activity of Chrysanthemum Morifolium Flower in Ethanol and Aqueous Extract
Chrysanthemum morifolium, also known as ‘Bunga Kekwa’ in Malaysia, is a perennial plant that belongs to the genus Chrysanthemum, a member of the Asteraceae family and is recognised for its medicinal properties. In Traditional Chinese Medicine (TCM), C.morifolium, commonly known as Juhua is renowned for its dietary and healthcare applications and has been consumed as a flower tea. This study investigated the antioxidant potential of C. morifolium extracts obtained using ethanol and aqueous solutions. Through phytochemical screening and antioxidant assay, this study identifies the type of bioactive compounds present in C. morifolium, particularly phenolic and flavonoid, which are well known for their antioxidant properties and ability to combat stress. Phytochemical screening revealed that both extracts had positive results for saponin, tannins, phenols, cardiac glycosides, and terpenoids, while flavonoids and coumarins were found only in the ethanol extract. The ethanolic extract exhibits strong antioxidant activity in FRAP assay in all tested concentrations (0.5 mg/ml, 1.0 mg/ml, 2.0 mg/ml) with FRAP value (0.5 mg/ml = 0.137742 mM, 1.0 mg/ml = 0.349080 mM, 2.0 mg/ml = 0.959058 mM) respectively, compared to the aqueous extract with FRAP value (0.5 mg/ml = 0.091331 mM, 1.0 mg/ml = 0.111387 mM, 2.0 mg/ml = 0.246146 mM), indicating dose-dependent antioxidant activity. The ethanolic extract exhibits strong antioxidant activity with a TEAC value (1.0 mg/ml = 0.010556 mg TE/ mg, 2.0 mg/ml = 0.015540 mg TE/ mg) in two out of three tested concentrations compared to the aqueous extract (1.0 mg/ ml = 0.004471 mg TE/ mg, 2.0 mg/ml = 0.008677 mg TE/mg). In conclusion, the ethanol extract of C. morifolium has shown potential as a natural antioxidant.
Copyright (c) 2025 Asian Journal of Medicine and Biomedicine
Phytochemical Screening and Antioxidative Potentials of Plectranthus Amboinicus Leaves Extract
Abstract Oxidative stress, resulting from an imbalance between reactive oxygen species (ROS) and the body’s antioxidant defense system, plays a critical role in the development of non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, and cancer. These diseases are increasingly prevalent in Malaysia, contributing significantly to national morbidity and mortality. While synthetic antioxidants are widely used, their potential health risks have prompted an increased interest in safer, plant-derived antioxidants as alternatives. Plectranthus amboinicus, also known as Cuban oregano, or pokok bangun-bangun, is traditionally used to treat respiratory conditions, digestive disorders, and fever. Although the plant’s biological activities are widely studied, there is still limited research done on the P. amboinicus plant from Malaysia. This study aimed to investigate the phytochemical constituents and antioxidant activity of P. amboinicus leaves collected in Terengganu, Malaysia. In this study, the crude methanol and aqueous P. amboinicus extract were prepared using a combination of maceration and ultrasound-assisted extraction techniques. Then, phytochemical screening, total phenolics, and total flavonoids content were conducted to identify bioactive substances. The antioxidant activity of the leaves was assessed using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP) assay. Findings revealed the presence of flavonoid, phenolic, coumarin, and cardiac glycoside in the extract. Quantitative analysis demonstrated that the methanol extract exhibited higher flavonoid (21.27 ± 4.85 mg QE/g) and phenolic content (59.96 ± 18.48 mg GAE/g) when compared to the aqueous extract. The DPPH scavenging activity is also significantly higher in the methanol extract, with the IC50 of 76.23 ± 32.74 μg/ml when compared to the aqueous extract (112.04 ± 45.02 μg/mL). Similar trends were observed in FRAP assay, with the value of 0.38 ± 0.025 mM Fe2+/g extract for methanol and 0.31 ± 0.13 mM Fe2+/mg extract for aqueous, respectively. The study highlighted the presence of a significant amount of phenolics and flavonoids in the extract, emphasizing their significant impact on the antioxidant properties of P. amboinicus extract. In conclusion, P. amboinicus exhibits antioxidant activity and has the potential to be used as a natural antioxidant. Keywords: Plectranthus amboinicus, Phytochemicals, Total Flavonoid, Total Phenolic, Antioxidant.
Principal Factor and Reliability Analysis of the Malay Version of DASS21, CBI and Brief COPE Questionnaire Among Malaysian OSH Competent Person
Background: Questionnaire has long been one of the acceptable form of data collection tools for medical and health sciences. It is convenient and reliable when used and psychometrically tested to the intended populations. This study aims to evaluate the principal factor and reliability analysis of the Malay versions of DASS21, CBI and Brief-COPE questionnaire among Malaysian OSH competent person. Methods: A total of 40 OSH competent persons participated in the study. IBM SPSS Statistics for Windows, Version 26.0 software was used for statistical analysis. Principal Factor Analysis was computed to assess factor analysis, while Cronbach's alpha and the intraclass correlation coefficient for individual items were used to measure the internal consistency and reliability of the questionnaires. Results: Principal Factor Analysis revealed that the number of components and items in each questionnaire aligned with the original versions, and the Kaiser’s criterion along with Cattell’s rule supported the appropriate number of factors to be retained for each questionnaire. Reliability testing indicated that all questionnaires demonstrated high internal consistency and exhibited good to excellent reliability, with Cronbach’s alpha values ranging from 0.900 to 0.951 and intraclass correlation coefficient values ranging from 0.895 to 0.946. Conclusion: This study showed that the Malay versions of DASS21, CBI and Brief-COPE questionnaires are validated tools for use among Malaysian OSH competent persons.
A Retrospective Analysis of Sociodemographic, Comorbidity and Lifestyle Risk Factors in Colorectal Cancer Patients: A Single Centre Experience from 2010-2018
Colorectal cancer (CRC) is a significant global health concern, exhibiting high mortality and incidence rates in Malaysia. It constitutes 13.5% of new cancer cases in the country, with a higher prevalence among males. Despite this, studies on colorectal cancer risk factors in a multi-ethnic population in a private hospital setting are rare. The primary objective of this study was to identify sociodemographic factors, comorbidities, and lifestyle factors associated with CRC and to examine CRC risk factors among patients diagnosed with CRC and matched non-CRC controls treated at a private hospital between 2010 and 2018. A retrospective case-control study was performed at a private hospital in Seremban, Malaysia. The study included 25 Malaysian residents diagnosed with histologically confirmed CRC, who received treatment at the hospital between 2010 and 2018. The control group consisted of 50 non-CRC patients who were randomly chosen from the same hospital during the same time frame. Descriptive statistics were used to summarise variables, and multiple logistic regression analysis was performed to identify risk factors for CRC. CRC patients had a mean age of 63 years compared with 50 years for controls, with a higher proportion being female (56.0% vs. 36.0%) and Chinese (60.0% vs. 32.0%). They also showed increased rates of diabetes mellitus (76.0% vs. 36.0%) and colon polyps (36.0% vs. 4.0%). Multiple logistic regression showed that each one-year increase in age was associated with 12% higher odds of CRC (OR 1.12, 95% CI 1.03 - 1.21). Diabetes mellitus was linked with nearly 10-fold higher odds (OR 9.69, 95% CI 1.64 - 57.40), and colon polyps with 62-fold higher odds (OR 62.03, 95% CI 3.50 - 1100.23). This study identified a significantly higher risk of colorectal cancer in individuals with diabetes, older age, and history of colon polyps. Hypertension, heart disease, smoking, and alcohol consumption were not found to be significantly associated. These findings require confirmation using a larger, diverse sample. Regular monitoring of high-risk groups, especially those over 50 years of age with diabetes or colon polyps, is crucial for early detection and reduction of the impact of colorectal cancer.
Effect of Tualang Honey on Candida albicans Biofilms
Candida albicans is the most common fungal pathogen associated with fungal biofilm, capable of causing superficial mucosal infections and life-threatening systemic infections in humans. This study was conducted to evaluate the in vitro inhibitory activity of Tualang honey on early-phase and mature (established) biofilms of C. albicans. The kinetic profiles of biofilms were assessed using the XTT reduction assay and field-emission scanning electron microscopy (FESEM). The minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) of Tualang honey were determined through a two-fold serial dilution method, with concentrations ranging from 5% to 80% (w/v). The XTT assay and FESEM were also utilised to evaluate the inhibitory effects of Tualang honey on both early-phase and established biofilms of C. albicans. The early and maturation phases of biofilms were attained after 4 to 12 hours and 48 to 72 hours, respectively. The lowest MIC value of Tualang honey against C. albicans was 80% (w/v). The MFC was undetermined within the tested concentrations. Tualang honey exerted its effect on biofilms by slowing the formation of early-phase biofilms and reducing the size of established biofilms by disintegrating their structures at high concentrations. The FESEM results indicated that this honey caused roughening of the cell surfaces and a decrease in biofilm biomass. The findings from this study suggest that Tualang honey, when applied at a high concentration of 80% (w/v), exhibits a fungistatic-like effect by inhibiting the proliferation of adherent fungal cells and disrupting the structural integrity and stability of biofilms, thereby hindering their further development and maturation.
Differences in Interleukin-6 Levels in Controlled and Uncontrolled Type 2 Diabetes Mellitus Patients at Dr. M. Hatta Brain Hospital Bukittinggi
ABSTRACT Diabetes Mellitus is an epidemic disease worldwide. Type 2 diabetes mellitus (T2DM) is characterized by hyperglycemia which results in inflammation. The inflammatory process will stimulate a non-specific immune response, macrophages will be activated to produce and secrete inflammatory cytokines so that there is an increase in cytokine levels, one of which is Interleukin-6 (IL-6). High levels of Interleukin-6 (IL-6) in T2DM patients cause insulin resistance and β-cell function failure. The role of Interleukin-6 (IL-6) in the pathogenesis of T2DM is considered an independent risk factor in the development of T2DM. This study aims to compare Interleukin-6 (IL-6) levels in Controlled and Uncontrolled T2DM patients. The study design was cross-sectional. Sample: Inpatients and outpatients at the DR. Drs. M. Hatta Bukittinggi Brain Hospital with a diagnosis of DMT2. The diagnosis of DMT2 was confirmed by examining blood sugar levels. Samples that met the inclusion and exclusion criteria consisted of 32 people with controlled DMT2 and 32 people with uncontrolled DMT2. The total sample was 64 people. Interleukin-6 (IL-6) levels were examined using the ELISA (Enzyme Linked Immunosorbent Assay) method. Data normality was tested using the Shapiro-Wilk test. Data analysis used the Mann Whitney test. IL-6 levels in controlled T2DM patients were 69.86 pg/ml (57.95 – 114.32pg/ml). IL-6 levels in uncontrolled T2DM patients were 77.80 pg/ml (58.04 – 135.51 pg/ml). IL-6 levels in uncontrolled T2DM patients were higher than those in controlled T2DM patients. Interleukin-6 levels in uncontrolled T2DM patients were higher than those in controlled T2DM patients. There was a significant and statistically significant difference. Keywords: Interleukin-6, Type 2 Diabetes Melitus Tipe 2 (T2DM), Controlled and Uncontrolled
Haemostatic Changes in Covid-19 Patients at Tertiary Hospital in East Coast Malaysia
COVID-19 is primarily seen as a respiratory infection, but recent research suggests it should be considered a systemic disease. This is due to its effects on the hematopoietic and haemostasis systems, leading to systemic imbalances and coagulation dysfunction, which have been observed in severely ill COVID-19 patients and fatalities. This study aims to evaluate the trend of haemostatic changes in COVID-19 patients at Hospital Pakar Universiti Sains Malaysia (USM). A retrospective study was carried out in the Haematology laboratory by analyzing data retrieved from the Laboratory Information System from July 2021 to July 2022. The study included 34 COVID-19 patients over 18 years of age, categorized into severe and non-severe groups. Demographic data and haematology parameters such as Prothrombin time, activated partial thromboplastin time, fibrinogen and D-dimer were collected. Fisher's Exact Test was used to analyze the association between demographic variables and the clinical severity of COVID-19, while the independent t-test and Mann-Whitney U test were employed to compare haemostatic parameters with clinical severity. The results showed that males (64.7%) and individuals aged 60 years and older (74.2%) were the most affected population at Hospital Pakar USM, with diabetic mellitus (64.5%) and hypertension (77.4%) being the most common comorbidities. There were marked increase in haemostatic parameters in the severe group of COVID-19, suggesting a direct relationship with clinical severity. However, no significant association was found between demographic data and haemostatic parameters with clinical severity of COVID-19. This study highlights the importance of haemostatic parameters concerning COVID-19 severity for better prognosis evaluation, management, and treatment.
Are We Fighting a Lost Cause? Gay Applications and the HIV Epidemic amongst Young Adults in Malaysia
The widespread use of geo-social dating applications among adolescents and young adults, particularly those identifying as homosexual, bisexual, or queer, has introduced both opportunities for social connectivity and heightened health risks. This case series presents three individuals aged 19 to 24 who engaged in early men who have sex with men (MSM) sexual encounters largely facilitated by online gay dating platforms. The cases illustrate common pathways to sexual initiation, including grooming by older adults, peer influence, and exposure through social media. All three individuals were diagnosed with human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) at a young age, prior to fully understanding the associated health risks. In addition to physical health complications, they experienced significant self-stigma and mental health challenges. This case series is particularly important in the Malaysian context, where sexual health education often lacks inclusivity and open discussions about MSM identities are limited by cultural and legal constraints. By highlighting these cases, we emphasize the urgent need for comprehensive, culturally sensitive digital sexual health education, early intervention, and protective measures tailored to the realities faced by youth in Malaysia.
Community Support for The Generational End Game Policy on Tobacco Control in Malaysia: A Cross-Sectional Study
The National Strategic Plan on Tobacco Control in Malaysia aims to reduce smoking prevalence to 15% by 2025 and achieve a tobacco-free nation by 2045. One of the strategies is to introduce the Generational End Game (GEG) policy to combat the persistently high smoking-related deaths and the growing popularity of vaping among youth. This study investigates community support for the policy, as well as the factors associated with their support. A cross-sectional study was conducted among all adult residents of Kampung Batu Buruk, Kuala Terengganu. A house-to-house survey was carried out, inviting these residents to participate in the study by completing a self-administered questionnaire. Multiple logistic regression was used to identify the significant factors associated with community support for GEG. Among 421 participants aged 18 to 88, 88.1% (95% CI:0.85,0.91) supported the GEG policy. Significant factors associated with support included non-smoking/non-vaping status (ORadj: 15.61, 95% CI: 5.97, 0.77, p < 0.001), absence from cigarette trading (ORadj: 11.06, 95% CI: 1.35, 90.72, p = 0.025), awareness of the GEG policy (ORadj: 6.17, 95% CI: 1.61, 23.71, p = 0.008), and a positive attitude towards it (ORadj: 14.27, 95% CI: 5.66, 35.99, p < 0.001). The findings underscore robust community backing for the GEG policy, particularly among non-smokers, non-vapers, and those uninvolved in cigarette trading. Awareness of the policy and positive attitudes emerged as key influencers. The study emphasizes the necessity of public education and awareness initiatives to cultivate support for the GEG policy, which is crucial for addressing the challenges posed by smoking and vaping, especially among the youth, in achieving Malaysia's goal of a tobacco-free status by 2045.
Religious Cognitive Behavioural Therapy (RCBT) for Chronic Disease : A Case Report
ABSTRACT This is a case report on the effectiveness of religious cognitive behavioural therapy (RCBT) sessions on a patient with underlying chronic diseases with poor adherence to treatment associated with mental disorder comorbidities. Recently, it has been widely accepted that more attention should be given to spirituality as spiritual health is recognised as the fourth dimension of health by the World Health Organisation (WHO). We explore the role of RCBT, which is an alternative method of managing medical illnesses with poor adherence to treatment.
Case Series of Cold Agglutinin Syndrome: A Malaysian Teaching Hospital Experience.
Cold agglutinin syndrome (CAS) is a rare form of autoimmune haemolytic anaemia mediated by cold agglutinins and characterized by an identifiable underlying cause. This case series presents three patients with CAS, each having a different secondary cause: neoplastic, autoimmune, and infection-related. Each case highlights the clinical presentation, diagnostic challenges, and therapeutic approaches specifically tailored to the underlying cause. The series underscores the importance of identifying secondary causes of CAS to guide treatment decisions. Management varies from immunosuppressive therapy and infection control to targeted treatments for underlying malignancies. These cases emphasise the need for a high index of suspicion in patients with haemolytic anaemia and cold agglutinin activity.
The Incidence and Clinicopathological Factors Associated with Bone Marrow Infiltration among Adult Lymphoma Patients in Malaysia
Introduction: The bone marrow (BM) is the most common site of extra nodal involvement in lymphoid malignancies BM assessment for lymphoma infiltration is crucial for lymphoma disease staging and can influence management and disease prognosis. Aim and objectives: This study aimed to determine the factors associated with bone marrow infiltration (BMI) among adult lymphoma patients in our centre. Methods: This was a cross-sectional study using retrospective clinical and laboratory data collected from 132 adult lymphoma patients investigated for BMI. BMI was determined by BM trephine biopsy with or without BM aspiration. Simple and multiple logistic regression were used for statistical analysis, and a p-value of less than 0.05 was considered significant. Results: The mean age of patients was 48.6 years, with the majority being Malay (94.7%), male (61.4%) and B-NHL (63.6%). The overall incidence of BMI was 22.7% (30/132) and was higher in NHL than HL, at 28.2% (29/103) and 3.4% (1/29), respectively. Among NHL patients, the incidence of BMI by T-NHL was higher than by B-NHL, at 36.8% (7/19) and 26.2% (22/84), respectively. There was a significant association between BMI and platelet (Plt) level (p = 0.015), type of lymphoma (p = 0.021) and grade of lymphoma (p = 0.026). The only dependent factors for BMI were T-NHL, indolent lymphoma and haemoglobin (Hb) level, with the odds ratio of 23.167 (p = 0.006), 4.433 (p = 0.009) and 0.770 (p = 0.022), respectively. Conclusions: Patients with T-NHL, indolent lymphoma and lower haemoglobin level have significant risk for BMI. We recommended BM assessment for patient with NHL, indolent lymphoma and patient with low Plt and Hb level.
Three Fundamental Statistical Elements in Cell Culture-Based Anticancer Studies
Statistical analysis is the backbone of research, and replication is essential to ensure robustness, reliability, and reproducibility of data. Fundamentally, inferences are drawn from datasets that include both technical and biological replicates. This piece highlights the replication, analysis, and presentation of data from cell culture-based anticancer studies.
A Second Malignancy of Multiple Myeloma in a Patient with Jak2v617 Positive Myeloproliferative Neoplasm
Multiple myeloma (MM) and myeloproliferative neoplasms (MPNs) are different types of haematological malignancies with distinct cellular origins. JAK2V617F mutation can be detected in polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF), which are characterized by clonal proliferation of hematopoietic stem cells in bone marrow. MM is characterized by the proliferation of a single clone of plasma cells that produce a monoclonal protein and leading to extensive skeletal involvement with osteolytic lesion resulting in hypercalcemia, anaemia and renal derangement. A 60-year-old Malay man was diagnosed with JAK2 V617F positive PV, presenting with splenomegaly and polycythemia. He responded well to hydroxyurea and aspirin until 10 years later, when he developed pancytopenia, splenomegaly, and worsening renal function. Bone marrow biopsy revealed MM. Immunohistochemical staining showed lambda light chain restriction, and serum protein electrophoresis confirmed monoclonal paraprotein. Skeletal survey revealed multiple lytic lesions. He was diagnosed with lambda light chain MM and started on appropriate therapy. The increased risk of developing second malignancies in a patient with MPNs has been reported for both non-haematological and haematological malignancies, but the cases have rarely been reported in the literature. Therefore, a case of second malignancy of multiple myeloma in a patient with JAK2 V617F-positive MPN will be highlighted in this article.
Catamenial Hemoptysis Secondary to Giant Mediastinal Endometriosis with Pericardial Involvement. A Case Report of Thoracic Endometriosis Syndrome.
Catamenial hemoptysis with mediastinal and pericardial involvement is a rare presentation of Thoracic Endometriosis Syndrome (TES) which is seldom proven via histopathology. TES is a clinical manifestation of the presence of endometrial tissue within the thorax cavity. Typically, it is being described as consisted of 4 components including catamenial pneumothorax, hemothorax, hemoptysis and pulmonary nodules1. Some even suggested to include catamenial chest pain, pleural effusion and even diaphragmatic hernia2. The pathophysiology of TES still is being debated and often considered as multifactorial3. The basis of the theory behind pathophysiology of TES is based on their clinical presentation and predominance characteristics and hence the description of variety presentation of TES is important to be documented as it will help us to develop more understanding regarding this syndrome. We reported a case of catamenial hemoptysis secondary to large anterior mediastinal endometriosis with radiological, operative imaging and histopathological evidence of mediastinal and pericardial involvement.
Raja Muhammad Burhanudeen Afiq Bin Raja Badrol Hisham
Anas Sjahroeddin Ressang Bin Hj Aminuddin
Scurvy: Bringing the Forgotten Disease to Society's Attention – Department of Radiology, Hospital Sultanah Nur Zahirah's (HSNZ) Perspective
Vitamin C also known as antisorbutic vitamin, L-xyloascorbic acid, 3-oxo-Lgulofuranolactone and L-3-ketothreohexuronic acid. It is essential for the production of collagen, a protein necessary for healthy skin, blood vessels, bones and cartilage. For humans, we unable to synthesize vitamin C endogenously, so it is an essential dietary component. Deficiency of vitamin C causes disease known as scurvy. Scurvy may be considered almost nonexistent in this modern era. However, we encountered 6 cases of scurvy in children at our hospital in 2024. The children were admitted due to complaints of an inability to walk properly or refusal to walk, which can mimic several other common conditions, particularly neurological and rheumatological disorders. The rarity of its occurrence, combined with a lack of understanding about modern-day risk factors for nutritional deficiency, often leads to delayed recognition of the condition. The provisional diagnosis of scurvy was made through proper clinical history-taking, physical examination, dietary history, and radiological findings showing pathognomonic features. All the 6 cases were confirmed by serum vitamin C levels. While serum vitamin C level is the gold standard for diagnosing scurvy, it is not easily accessible in many centers, including our hospital, therefore the understanding and recognition of the pathognomonic radiological features will assist in reaching the correct diagnosis.
Severe Pneumonia in Severe Kyphoscoliosis: A Non-Invasive Ventilation as a Weaning Strategy
Severe kyphoscoliosis, characterized by a combined deformity of kyphosis and scoliosis, presents a unique challenge to respiratory function, predisposing individuals to heightened susceptibility to respiratory complications. We present a case report detailing the management of severe pneumonia in a 37-year-old lady with severe kyphoscoliosis, shedding light on the complexities of this clinical scenario and the pivotal role of non-invasive ventilation (NIV) as a weaning strategy. The patient's pre-existing severe kyphoscoliosis posed significant respiratory limitations, leading to restrictive lung disease and impaired pulmonary function. Hospitalization was necessitated by severe pneumonia, and the intricate relationship between the spinal deformity and the respiratory infection became apparent. The compromised chest wall mechanics and reduced lung compliance in severe kyphoscoliosis exacerbated the challenges of managing the severe pneumonia. A comprehensive approach was undertaken, emphasizing the judicious use of NIV as a weaning strategy from mechanical ventilation. NIV served not only as a supportive measure but also as a strategic tool in optimizing alveolar ventilation and reducing the work of breathing. The case highlights the successful application of NIV in navigating the intricacies of weaning in the context of severe pneumonia and severe kyphoscoliosis.
Decalcification Agents for Histological Analysis of Human Dental Tissues: A Review
Background: In histopathology laboratories, fixation and decalcification are essential steps that are carried out during the processing of mineralised tissues such as bone and teeth. While formalin or formaldehyde have been universally accepted as the two fixative solutions that most laboratories use, no such decalcifying agent has been reported. Objective: The present review aims to compare and discuss the various decalcifying agents used for the decalcification of human teeth with a focus on the effect of these agents on the overall structure and staining qualities of decalcified tissues. Study Design: Five electronic databases were searched for relevant studies using specific keywords. Papers that studied decalcification of bones or non-human teeth were excluded from this study. Results: The literature search resulted in 11 studies that were conducted between 2007 and 2021. These papers discuss various dental pulp access methods, fixatives, decalcifying agents and decalcification conditions. Conclusion: Despite the importance of decalcification for sectioning and staining of hard tissues, there is no consensus among histopathologists and researchers on a standard decalcifying solution. The choice of decalcifying agent is primarily influenced by staining characteristics and the rate of decalcification, which may vary according to the specific needs of the pathologist or researcher.
The Impact of Fluorosis in Neurological Disorders: A Mini-Review
The purpose of the present review is to update and conclude available evidence of risk of fluorosis associated with neurological disorders. Neurological disorders are diseases of the central and peripheral nervous system which includes the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots. Alzheimer disease, dementia, Parkinson's disease, neuropathy, Autism, and memory and learning deficits are considered as neurological disorders. Globally 47.5 million people are affected by dementia and 7.7 million new cases are found every year. Alzheimer's disease is the main reason for developing dementias in 60–70% of cases. Fluorosis is a metabolic bone disease which is produced due to prolonged exposure to excessive amounts of fluoride through various sources. Extreme fluoride exposure may possibly consequence to central nervous system dysfunction. Chronic fluorosis might play a role in Alzheimer’s disease, as it is common among people living in endemic fluorosis regions. High levels of fluoride exposure may have the risk of impaired intelligence in children. Excessive ingestion of fluoride leads to calcification of ligaments and tendons causes compression on nerve structures and produces myelopathy and radiculopathy. Fluoride can cross the blood-brain barrier especially at the time of pregnancy period leading to develop neural deterioration of offspring which promotes learning and memory impairments. The present review attempts to elucidate the possible relationship between fluorosis and neurological disorders.
Severity of Eczema and Quality of Life among Caregivers with Eczema Children in Puncak Alam, Selangor
Eczema is the most prevalent chronic inflammatory dermatosis. It has a substantial negative impact on both the quality of life and the health of both children and their families. This study was done to determine the severity of eczema and the quality of life among caregivers with eczema children in Puncak Alam. This study adopts a quantitative approach with a cross-sectional design. A total of 295 caregivers with eczema children involve in this study. The instruments used are Patient-Oriented Eczema Measure (POEM) and Dermatitis Family Impact (DFI). The severity of eczema among children in Puncak Alam showed that 42.8% experienced moderate symptoms. Caregivers reported have significant impacts on their quality of life, with 51.7% experiencing disturbed sleep and 36.7% facing emotional distress. Statistical analyses highlighted associations between eczema severity and sociodemographic factors, including family income and allergy status (p < 0.05). These findings highlight the importance of focused interventions that support both children with eczema and their caregivers, highlighting the significance of comprehensive care approaches.
Bone Health Status, Isokinetic Muscular Peak Torque and Power, and Body Composition of Malaysian Young Male Taekwondo and Wushu Practitioners
The aim of this study was to determine the differences of bone health status, isokinetic muscular strength and power, and body composition among Malaysian young male taekwondo and wushu practitioners in Malaysia. Thirty Malaysian participants with mean age 15.6 ± 1.5 years old were recruited. The participants were divided into three groups, i.e. sedentary control, wushu and taekwondo groups. Participant’s percent body fat (%BF), fat-free mass, quantitative ultrasound measurement of bone speed of sound (SOS), and isokinetic muscular peak torque (an indicator of muscular strength), peak torque per body weight and average power of the participants’ knee and shoulder extension and flexion at angular velocities of 60o.s-1, 180o.s-1 and 300o.s-1 were measured. There were no significant differences in %BF and tibial and radial SOS of legs and arms among sedentary control, wushu and taekwondo groups. Besides, fat free mass was significantly higher (p< 0.05) in wushu and taekwondo groups compared to sedentary control group respectively. In general, wushu and taekwondo groups showed statistically significant higher values in most of the muscular peak torque and powers measurements compared to sedentary control group. Wushu group showed statistically significant (p< 0.05) higher values of isokinetic knee extension peak torque per body weight at 60o.s-1, 180o.s-1 and 300o.s-1 compared to taekwondo group. In addition, wushu group also showed significantly (p<0.05) higher values than taekwondo group in most of the isokinetic shoulder extension peak torque and power measured parameters. However, taekwondo group showed significantly (p<0.05) higher values than wushu group in almost all the isokinetic shoulder flexion peak torque and power measured parameters. In conclusion, engagement in wushu and taekwondo could enhance muscular strength and power compared to sedentary lifestyle. Besides, these findings imply that isokinetic knee and shoulder extension strength and power are essential muscular performance variables in wushu, whereas isokinetic shoulder flexion strength and power are essential muscular performance variables in taekwondo. Hence, the findings obtained from this study can be used to guide the sports bodies and coaches in planning specific training programmes, which focus on improving muscular performance variables in martial arts, i.e. wushu and taekwondo in Malaysia.
Rare Variants of Prostatic Carcinoma: The Management Approach from Multicentre Experience in Malaysia
Objective Up to 99% of prostate cancer were adenocarcinoma. Stromal prostate sarcoma only contributes 0.1% of primary prostate malignancy, whereas basaloid cell carcinoma is even rare prostatic neoplasm. We retrospectively evaluated the details of these rare prostatic malignancies, the management approaches, and the clinical outcomes of our case series. Methods A total of six cases with rare variants of prostate malignancy were managed and retrospectively reviewed to evaluate the symptoms at presentation, diagnostic methods, and staging protocol from two tertiary hospitals in Malaysia from 2019 to 2023, comprising four cases of prostate sarcoma and two cases of basaloid cell carcinoma of the prostate. Histopathological findings and treatment modality were analyzed. Overall survival was assessed. Results: In this study of six patients with rare prostatic malignancies, four had prostatic sarcoma (three had high rhabdomyosarcoma and one had high-grade unspecified sarcoma) and two had basaloid cell carcinoma (BCC). The median age at presentation was 48 years for prostatic sarcoma and 35 years for BCC. Clinical presentations included urinary obstruction (n=4), perineal pain (n=1), and gross hematuria (n=1). All patients underwent transrectal ultrasound-guided biopsy and comprehensive staging, including CT, MRI, and bone scans. Treatment varied by disease type. Two patients with localized or locally advanced prostatic sarcoma received radical prostatectomy; one required postoperative chemoradiation due to positive surgical margins. The patient with locally advanced BCC underwent transurethral resection of the prostate (TURP) for symptom relief, followed by adjuvant radiotherapy (50 Gy) and androgen deprivation therapy (ADT). Systemic treatments included vincristine, Adriamycin, and cyclophosphamide for rhabdomyosarcoma, and cisplatin, Adriamycin, and ifosfamide for other sarcomas. The BCC patient received concurrent chemoradiotherapy with carboplatin, paclitaxel, and intensity-modulated radiotherapy (70 Gy). All advanced disease patients were treated with LHRH agonists. The median follow-up was 24 months. Median survival was 43 months for localized or locally advanced cases and 2 months for metastatic cases. Among prostatic sarcoma patients, median survival was 37 months for rhabdomyosarcoma and 1 month for other sarcoma subtypes. BCC patients had a median survival of 14 months. All patients with localized or locally advanced prostate cancer survived till today, including one prostatic sarcoma patient with positive surgical margin post-prostatectomy with lung metastases during follow-up. Three patients with metastatic disease at presentation experienced death during follow-up. Conclusion Managing rare prostatic malignancies is complex and requires personalized approaches. Radical surgical resection remains the most effective treatment for locally advanced prostatic cancer disease. Systemic treatments offer limited benefits, especially for metastatic cases. Further research is needed to refine management strategies and improve patient outcomes. Keywords Sarcoma, Basaloid Cell Carcinoma, Prostate Cancer
Current Chemotherapy Strategies for Colorectal Cancer: Challenges and Future Directions
Colorectal cancer (CRC) poses a significant global health challenge, ranking as the third most prevalent cancer and the second leading cause of cancer-related mortality. The development of CRC is driven by genetic mutations, environmental factors, and lifestyle choices. Over recent decades, chemotherapy has played a crucial role in CRC treatment. Key chemotherapeutic agents such as 5-fluorouracil, capecitabine, irinotecan, oxaliplatin, and trifluridine/tipiracil have sig-nificantly improved patient outcomes. However, chemotherapy for CRC still faces significant challenges, including severe side effects, drug resistance, and high costs. This review discusses the current status and recent advancements in chemotherapy strategies for CRC, delves into the challenges the field faces, and proposes future research directions to foster the development of more effective chemotherapeutic drugs for CRC.
Immunomodulatory Effects of Anacardium occidentale Leaves Extract on RAW 264.7 Mouse Macrophage Cell Lines
Macrophages are specialist cells in immune system that recognize, engulf, and eliminate pathogens. Furthermore, they have the ability to present antigens to T cells and start an inflammatory response by producing cytokines that stimulate other cells. Macrophage play a major role in innate immunity. Altered immune system may lead to numerous immune-related diseases. Unfortunately, synthetically produced drugs may cause long-term adverse or side effects when consumed such as liver cirrhosis and kidney failure. Due to this, it is essential for researcher to find or develop alternative medicine that able to give immunomodulatory effects without causing adverse or side effects. Based on community believe, Anacardium occidentale has the potential to be an immunomodulatory agent. However, there is still lack of scientific prove to support the statement. Hence, the in vitro was done to determine the immunomodulatory effects of A. occidentale on innate immunity of RAW 264.7 mouse macrophage cell lines. The normal model of the macrophages was cultured and treated with three different treatments for 24 hours. These treatments include different concentration of A. occidentale methanolic extract as treated cells, LPS-induced macrophages as positive control and 0.05% of dimethyl sulfoxide as untreated cells. The cytotoxicity effects on the macrophages were observed through MTT assay (viability percentage) and morphological changes. The results indicate that there were no cytotoxicity effects because no significant different of viability percentage for A. occidentale methanolic extract treated cells when compared to untreated cells. Additionally, treatment of 100 µg/mL, 25 µg/mL and 6.25 µg/mL significantly improve rate of migration and wound closure as compared to the untreated macrophages. As a nutshell, this plant has the potential as immunostimulant agent to prevent infectious diseases.
Lemierre’s syndrome, also known as post-anginal septicemia is a rare entity characterized by a triad of septicemia, internal jugular vein thrombophlebitis and metastatic septic emboli secondary to acute pharyngeal infections. It is commonly seen in young men, with 70% of patients between 16 and 25 years old. Lemierre’s syndrome shows various clinical presentations, thus recognizing this disease in early stage is difficult. Thus, higher clinical suspicion is required to establish the diagnosis of Lemierre’s syndrome. This case report describes a rare presentation of Lemierre’s syndrome in a 64-year-old lady who presented with acute onset of anterior neck swelling associated with progressive fatigue, pain and fever for one-week duration. Physical examination at admission found that she was feverish with tachycardia. Oxygen saturation was maintained under room air, and she was not hypotensive. A neck examination revealed soft anterior neck swelling without evidence of clinical inflammation. Further imaging showed retropharyngeal space collection with thrombosis of bilateral internal jugular veins. She was managed with broad-spectrum antibiotic coverage and subsequently achieved full recovery. Our main objective is to highlight the importance of recognizing and diagnosing Lemierre’s syndrome in older population to achieve appropriate treatment and management.
Carvacrol-Loaded Nanoemulgel for Improved Antifungal Effect
Introduction: Fungal infections of the skin, hair, and nails affect a significant portion of the global population, with dermatophyte infections being particularly common. Topical and oral antifungal medications often face challenges in efficacy and side effects. Carvacrol (CRV), a natural fungicidal agent, has shown promise in treating fungal infections but is limited by poor skin penetration. Aim: This study aims to develop a novel CRV-loaded nanoemulgel formulation to enhance antifungal effect. Methods: A CRV-loaded nanoemulsion was created using a combination of CRV, paraffin oil, surfactant (tween 80) and co-surfactant (span 80) to stabilize nanosized oil droplets. Processing parameters effect on the nanoemulsion particle size and distribution were investigated. Various concentrations of surfactants and HLB values were tested to determine the optimal nanoemulsion formulation. The antifungal effect of the optimal CRV-loaded nanoemulsion and nanoemulgel formulations against Candida albicans was evaluated in vitro using microdilution and well diffusion methods. Results: The optimal particle size of 303.2 nm was achieved with a homogenization time of 3 minutes and sonication at 20% power for 3 minutes. A surfactant concentration of 12% and HLB value of 10.5 produced a homogeneous mixture. The CRV-loaded nanoemulgel exhibited non-Newtonian shear-thinning behaviour. The MIC of the CRV solution and nanoemulsion against Candida albicans were 0.25 and 0.1 mg/ml, respectively. The CRV-loaded nanoemulsion and nanoemulgel demonstrated the highest zones of inhibition against Candida albicans (12 and 9.5 mm, respectively), outperforming the CRV solution and the reference drug, clotrimazole (1.5 and 7.5 mm, respectively). Conclusion: The developed CRV-loaded nanoemulgel showed enhanced antifungal activity, thus offering a promising alternative for the treatment of fungal infections. This formulation has the potential to improve the treatment outcomes and reduce the side effects associated with conventional antifungal medications. Further studies in-vivo are warranted to optimize the formulation for clinical use.
A Review of the Second Mesiobuccal (MB2) Canal in Maxillary Molars Across Different Demographic Factors: Gender, Age, and Geographic Region
Introduction: The root canal system has always been one of the most complicated aspects of dentistry, especially in endodontic. Lack of knowledge about the root canal system could lead to missing the additional root canal, which can later cause the endodontic treatment failure. The second mesiobuccal (MB2) canal which is the popular additional canal in maxillary molar is one of the most discussed topic. There will be different variations regarding the MB2 canal in various demographic factors. Thus, gender, age and geographical region factors should be considered to determine the anatomical variability and the frequency of the MB2 canal. Objectives: To review the available evidences on the prevalence of MB2 canal among different demographic factors such as gender, age and geographical region. Methods: Literature search was performed using PubMed, Scopus, Medline and Google Scholar databases to identify the related articles using systematic search strategy. Results: From the available evidences among the selected articles, the prevalence of MB2 canal is 43.6%-73.0% in male and 23.2%-71% in female. The prevalence of MB2 canal is 27.3%-74.4% in younger age group and 10%-69.4% for the older age group. The prevalence of MB2 canal is 52.0%-57.8% in China and 45.6%-59.9% in Malaysia. Conclusion: According to the gender, the prevalence of MB2 canal is more frequent in male compare to female. In the age group aspect, the prevalence of MB2 canal is more frequent in the younger compare to older age group. The pattern also showed that the prevalence of MB2 canal varies randomly regardless of any geographical region. Keywords: Literature review, second mesiobuccal (MB2) canal, gender, age, geographical region
Unmasking the Enigma: Progressive Neurocognitive Decline in a Thriving Adolescent
The neurocognitive deterioration accompanied by behavioral disturbance in adolescent or young adult poses a great diagnostic challenge. While there is a tendency to equate behavioral change or disturbance to psychiatric causes, it is essential to consider organic causes, especially when there are other features that would raise clinical suspicions such as progressive neurocognitive decline and the atypicality of the presentation. This case illustrates a male adolescent with a background of normal development, intellectual and adaptive functioning. He presented with slowly progressive neurocognitive decline since the age of 14 years old. The symptoms became prominent when he started to become forgetful and had deterioration of school performance. His speech and comprehension started to trouble, together with episodes of repetitive motor movements (eye-blinking, hand clenching, lip smacking, and mouth chewing) without impairment in awareness, episodes of bedwetting and daytime somnolence. Later, he portrayed worsening of behavioural disturbances, irritability and impulsivity with prominent ‘pseudo-regression’ in his general maturity and reasoning. Despite on antiepileptic and neuroleptic medication, he showed lack of improvement, raised the suspicion of possible autoimmune in origin. Patient partially responded with intravenous methylprednisolone and behavioural modifications. Unfortunately, the repetitive movement were persistent and EEG was repeated. There was no evidence of epileptiform discharges. The diagnosis of Tourette syndrome has been made eventually. Correct diagnosis is cardinal for effective treatment. In complex and difficult cases regular monitoring of the symptoms and response to treatment can be an indirect method in establishing one. In cases with such complex, non-specific initial presentation a thorough history taking, examination and investigations are crucial to rule out organic causes. This case is one of the important examples that warrants a great multidisciplinary management and effective communication between all the stakeholders. Keywords: Neurocognitive decline, adolescent, autoimmune.
Mantle Cell Lymphoma with Negative CCND1 FISH Studies: A Case Report
Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma characterized by overexpression of cyclin D1 due to a chromosomal translocation of t (11;14) (q13; q32) in most cases. This abnormal cyclin D1 expression is a key factor in diagnosing MCL. Morphologically, MCL typically manifests as a proliferation of small- to medium-sized cells with irregular nuclear contours. In aggressive variants, such as those comprising lymphoblast-like (blastoid) or pleomorphic cells, the disease course may be more rapid and challenging to manage. Notably, a rare cyclin D1-negative variant of MCL has been identified, characterized by translocations involving CCND2/cyclin D2. We present a case of MCL with negative CCND1/IGH rearrangement, contributing to the broader understanding of the disease's varied manifestations.
Screen-related Dependency in Children: Algorithm for Referral From Primary Care in Malaysia
The emergence of screen-related issues in children in recent years and the negative impacts on their development have further intensified the research and movements for their recognition and prevention. Studies have found multiple health concerns and significant associations with psychological disorders related to screen use, which led to the development of screening tools to identify these pre-school children for early measures. While there are general guidelines, i.e., limiting screen time by WHO, there are not yet any specific outlines or pathways provided for healthcare providers at the primary care level, especially in the Malaysian context. This algorithm was developed by a group of Malaysian experts for primary care, aiming to facilitate the early screening of screen-related dependency in pre-school children and its referral for psychological interventions. It was also designed for awareness and education for parents and caretakers, and essentially for the attention of primary healthcare providers.