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MyMedR (Malaysian Medical Repository) is an open access collection of Malaysian health and biomedical research. The materials are imported from PubMed and MyJurnal. We gratefully acknowledge the permission to reuse the materials from the National Library of Medicine of the United States and the Malaysian Citation Centre. This project is funded by Academy of Family Physicians of Malaysia. The project team members are: CL Teng, CJ Ng, EM Khoo, Mastura Ismail, Abrizah Abdullah, TK Chiew, Thanaletchumi Dharmalingam.

Please note that some citations are non-Malaysian publications. Common reasons are: (1) One or more authors had a Malaysian affiliation; (2) The article abstract mentioned Malaysia; (3) The study subjects included Malay ethnic group.

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  1. Notz Q, Lee ZY, Menger J, Elke G, Hill A, Kranke P, et al.
    Crit Care, 2022 01 19;26(1):23.
    PMID: 35045885 DOI: 10.1186/s13054-022-03896-3
    BACKGROUND: Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients.

    METHODS: A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL was conducted to identify all randomized controlled trials in critically ill patients published from inception to June 2021, which investigated clinical omega-6 sparing effects. Two independent reviewers extracted bias risk, treatment details, patient characteristics and clinical outcomes. Random effect meta-analysis was performed.

    RESULTS: 1054 studies were identified in our electronic search, 136 trials were assessed for eligibility and 26 trials with 1733 critically ill patients were included. The median methodologic score was 9 out of 14 points (95% confidence interval [CI] 7, 10). Omega-6 FA sparing PN in comparison with traditional lipid emulsions did not decrease overall mortality (20 studies; risk ratio [RR] 0.91; 95% CI 0.76, 1.10; p = 0.34) but hospital length of stay was substantially reduced (6 studies; weighted mean difference [WMD] - 6.88; 95% CI - 11.27, - 2.49; p = 0.002). Among the different lipid emulsions, fish oil (FO) containing PN reduced the length of intensive care (8 studies; WMD - 3.53; 95% CI - 6.16, - 0.90; p = 0.009) and rate of infectious complications (4 studies; RR 0.65; 95% CI 0.44, 0.95; p = 0.03). When FO was administered as a stand-alone medication outside PN, potential mortality benefits were observed compared to standard care.

    CONCLUSION: Overall, these findings highlight distinctive omega-6 sparing effects attributed to PN. Among the different lipid emulsions, FO in combination with PN or as a stand-alone treatment may have the greatest clinical impact. Trial registration PROSPERO international prospective database of systematic reviews (CRD42021259238).

  2. Fong SS, Foo YY, Saw WS, Leo BF, Teo YY, Chung I, et al.
    Int J Nanomedicine, 2022;17:137-150.
    PMID: 35046650 DOI: 10.2147/IJN.S337093
    Purpose: The use of nanocarriers to improve the delivery and efficacy of antimetastatic agents is less explored when compared to cytotoxic agents. This study reports the entrapment of an antimetastatic Signal Transducer and Activator of Transcription 3 (STAT3) dimerization blocker, Stattic (S) into a chitosan-coated-poly(lactic-co-glycolic acid) (C-PLGA) nanocarrier and the improvement on the drug's physicochemical, in vitro and in vivo antimetastatic properties post entrapment.

    Methods: In vitro, physicochemical properties of the Stattic-entrapped C-PLGA nanoparticles (S@C-PLGA) and Stattic-entrapped PLGA nanoparticles (S@PLGA, control) in terms of size, zeta potential, polydispersity index, drug loading, entrapment efficiency, Stattic release in different medium and cytotoxicity were firstly evaluated. The in vitro antimigration properties of the nanoparticles on breast cancer cell lines were then studied by Scratch assay and Transwell assay. Study on the in vivo antitumor efficacy and antimetastatic properties of S@C-PLGA compared to Stattic were then performed on 4T1 tumor bearing mice.

    Results: The S@C-PLGA nanoparticles (141.8 ± 2.3 nm) was hemocompatible and exhibited low Stattic release (12%) in plasma. S@C-PLGA also exhibited enhanced in vitro anti-cell migration potency (by >10-fold in MDA-MB-231 and 5-fold in 4T1 cells) and in vivo tumor growth suppression (by 33.6%) in 4T1 murine metastatic mammary tumor bearing mice when compared to that of the Stattic-treated group. Interestingly, the number of lung and liver metastatic foci was found to reduce by 50% and 56.6%, respectively, and the average size of the lung metastatic foci was reduced by 75.4% in 4T1 tumor-bearing mice treated with S@C-PLGA compared to Stattic-treated group (p < 0.001).

    Conclusion: These findings suggest the usage of C-PLGA nanocarrier to improve the delivery and efficacy of antimetastatic agents, such as Stattic, in cancer therapy.

    MeSH terms: Animals; Cyclic S-Oxides; Drug Carriers; Humans; Polyglycolic Acid; Dimerization; Chitosan*; STAT3 Transcription Factor; Mice; Nanoparticles*
  3. Shahwan M, Suliman A, Abdulrahman Jairoun A, Alkhoujah S, Al-Hemyari SS, Al-Tamimi SK, et al.
    J Multidiscip Healthc, 2022;15:81-92.
    PMID: 35046663 DOI: 10.2147/JMDH.S341700
    Objective: To evaluate the prevalence, knowledge, attitude and acceptance of the COVID-19 vaccines and related factors among university students in the United Arab Emirates.

    Methods: Analytical cross-sectional study undertaken among a convenient sample of medical and non-medical colleges of Ajman University using a self-administrated questionnaire. The questionnaire included demographic data as well as assessing knowledge of COVID-19, attitudes and acceptance of COVID-19 vaccines.

    Results: A total of 467 students participated in the study and completed the questionnaire. A total of 181 (38.8%) participants reported that they have been vaccinated against COVID-19 virus, principally with the Sinopharm vaccine (84%). Vaccination against the COVID-19 virus was less prevalent among Arabic nationalities compared to other nationalities, but more prevalent among students from health science colleges compared to those from non-health science colleges. The acceptance rate of COVID-19 vaccine among study participants was 56.3%, exacerbated by worries regarding unforeseen problems (65.5%, 306), general mistrust (47.3%, 221) and unforeseen impacts (35.1%, 164). The average knowledge score was 60.1%, with 142 (30.4%) having poor knowledge, 127 (27.2%) acceptable knowledge and 198 (42.4%) good knowledge. There were common misconceptions about symptoms including nausea and diarrhoea, as well as the route of transmission, with half believing antibiotics are effective treatment.

    Conclusion: There was variable knowledge of COVID-19 among students. Misconceptions need addressing going forward. To enhance COVID-19 vaccination uptake in the country and worldwide, health education targeting diverse sociodemographic categories should be prioritized.

  4. You YX, Shahar S, Mohamad M, Rajab NF, Che Din N, Lau HJ, et al.
    Front Hum Neurosci, 2021;15:765451.
    PMID: 35046782 DOI: 10.3389/fnhum.2021.765451
    Working memory is developed in one region of the brain called the dorsolateral prefrontal cortex (DLPFC). The dysfunction of this region leads to synaptic neuroplasticity impairment. It has been reported that several biochemical parameters and anthropometric measurements play a vital role in cognition and brain health. This study aimed to investigate the relationships between cognitive function, serum biochemical profile, and anthropometric measurements using DLPFC activation. A cross-sectional study was conducted among 35 older adults (≥60 years) who experienced mild cognitive impairment (MCI). For this purpose, we distributed a comprehensive interview-based questionnaire for collecting sociodemographic information from the participants and conducting cognitive tests. Anthropometric values were measured, and fasting blood specimens were collected. We investigated their brain activation using the task-based functional MRI (fMRI; N-back), specifically in the DLPFC region. Positive relationships were observed between brain-derived neurotrophic factor (BDNF) (β = 0.494, p < 0.01) and Mini-Mental State Examination (MMSE) (β = 0.698, p < 0.01); however, negative relationships were observed between serum triglyceride (β = -0.402, p < 0.05) and serum malondialdehyde (MDA) (β = -0.326, p < 0.05) with right DLPFC activation (R 2 = 0.512) while the participants performed 1-back task after adjustments for age, gender, and years of education. In conclusion, higher serum triglycerides, higher oxidative stress, and lower neurotrophic factor were associated with lower right DLPFC activation among older adults with MCI. A further investigation needs to be carried out to understand the causal-effect mechanisms of the significant parameters and the DLPFC activation so that better intervention strategies can be developed for reducing the risk of irreversible neurodegenerative diseases among older adults with MCI.
  5. Abd Rahman FN, Wong YY, Khalib AQ
    Front Psychiatry, 2021;12:772744.
    PMID: 35046852 DOI: 10.3389/fpsyt.2021.772744
    Postnatal depression is a major illness affecting maternal and family health. The rate of postnatal depression among mental health clients is postulated to be higher than in the community due to the added brain assault. Children of parents who are mental health clients are more likely to have psychological problems compared to children from other parents in the community. This study investigates the rate of postnatal depression among mental health clients and their offspring's psychological health. A total of 140 mental health clients were assessed using the Edinburgh Postnatal Depression Scale (EPDS). They subsequently completed the Strength and Difficulties Questionnaire (SDQ) regarding their children. The majority ethnicity was the Kadazan (40.7%). The mean age of mothers was 38.6 (7) years with most having a secondary education (53.6%) and a household income per month of < RM1000 per month (27.1%). The postnatal depression rate was 47.8%. Higher EPDS scores were associated with higher total SDQ scores in their offspring. Model 1 was unadjusted, giving an OR of 5.65 [95% CI (3.74, 7.55)], p < 0.001. After adjustment for confounders, Model 2 had an OR of 5.51 [95% CI (3.57, 7.46)], p < 0.001. More efforts need to be given to the early detection of maternal depression and its prompt treatment in mental health clients because of the relationship with the psychological health of the offspring.
  6. Kc B, Alrasheedy AA, Leggat PA, Molugulu N, Mohamed Ibrahim MI, Khatiwada AP, et al.
    Integr Pharm Res Pract, 2022;11:9-19.
    PMID: 35047377 DOI: 10.2147/IPRP.S345621
    Introduction: Pharmacists at airport pharmacies could offer essential health services for air travelers. Consequently, this study aimed to explore the type of professional services, the types of medicines at airport pharmacies and the pharmacists' experiences and views regarding their practices.

    Methods: A qualitative study was conducted with pharmacists practicing in airport pharmacies from June 2020 to December 2020. A validated Google form-based interview questionnaire was developed, and the electronic link was sent to the participants. Recruitment of participants was continued until data saturation was achieved. In total, 15 pharmacists working at different airport pharmacies in different countries were included. Thematic analysis was used in the data analysis.

    Results: The study identified six major themes including type of professional services and medicines at airport pharmacies, pharmacists' experiences, challenges at the airport pharmacy, suggestions to improve airport pharmacy services, pandemics and the role of pharmacists, and business aspect of the airport pharmacies. The study showed that several professional services provided at airport pharmacies, including the provision of medicines, health products, general health services, travel health services, and counseling. Moreover, 46.7% of the participants reported having a dedicated travel health service. In addition, most of the participants described their experience at airport pharmacies as good and exciting as they met different people from different countries. The most common challenges that pharmacists face at airport pharmacies include language barriers, requests for different medicine brands by travelers, and financial issues. The participants indicated that there is a need for promotion of pharmacists' role in providing health care services at airport pharmacies.

    Conclusion: The study showed that pharmacists could play vital roles in providing medicines and health care services for air travelers. However, there is still further scope for improvement in this sector of the pharmacy profession to ensure a more active role in travel medicine.

  7. Jeyamogan S, Khan NA, Sagathevan K, Siddiqui R
    BMJ Open Sci, 2020;4(1):e100040.
    PMID: 35047686 DOI: 10.1136/bmjos-2019-100040
    Background: Cancer remains a global threat resulting in significant morbidity and mortality despite advances in therapeutic interventions, suggesting urgency for identification of anticancer agents. Crocodiles thrive in polluted habitat, feed on germ-infested meat, are exposed to carcinogenic heavy metals, are the very few species to survive the catastrophic Cretaceous-Paleogene extinction event, yet have a prolonged lifespan and rarely been reported to develop cancer. Therefore, we hypothesised that animals living in polluted environments such as crocodiles possess anticancer molecules/mechanisms.

    Methods: Crocodylus porosus was procured, blood collected, dissected and lysates prepared from internal organs. Organ lysates and sera were tested for growth inhibition, cytotoxic effects and cell survival against HeLa, PC3 and MCF7 cells and subjected to liquid chromatography mass spectrometry. RNA transcriptome analysis and differential gene analysis were performed using Galaxy Bioinformatics.

    Results: Sera exhibited potent growth inhibition and cytotoxic effects against cancer cells. 80 molecules were detected from C. porosus and 19 molecules were putatively identified. Additionally, more than 100 potential anticancer peptides were identified from sera using bioinformatics based on peptide amino acid composition, binary profile, dipeptide composition and pseudo-amino acid composition. Following transcriptome analysis, 14 genes in treated HeLa cells, 51 genes in treated MCF7 cells and 2 genes in treated PC3 cells, were found to be expressed, compared with untreated controls.

    Conclusion: Animals residing in polluted milieus are an unexploited source for prospective pharmaceutical drugs, and could lead to identification of novel antitumour compound(s) and/or further understanding of the mechanisms of cancer resistance.

  8. Balkhoyor AM, Awais M, Biyani S, Schaefer A, Craddock M, Jones O, et al.
    BMJ Surg Interv Health Technol, 2020;2(1):e000040.
    PMID: 35047792 DOI: 10.1136/bmjsit-2020-000040
    Objective: Investigations into surgical expertise have almost exclusively focused on overt behavioral characteristics with little consideration of the underlying neural processes. Recent advances in neuroimaging technologies, for example, wireless, wearable scalp-recorded electroencephalography (EEG), allow an insight into the neural processes governing performance. We used scalp-recorded EEG to examine whether surgical expertise and task performance could be differentiated according to an oscillatory brain activity signal known as frontal theta-a putative biomarker for cognitive control processes.

    Design setting and participants: Behavioral and EEG data were acquired from dental surgery trainees with 1 year (n=25) and 4 years of experience (n=20) while they performed low and high difficulty drilling tasks on a virtual reality surgical simulator. EEG power in the 4-7 Hz range in frontal electrodes (indexing frontal theta) was examined as a function of experience, task difficulty and error rate.

    Results: Frontal theta power was greater for novices relative to experts (p=0.001), but did not vary according to task difficulty (p=0.15) and there was no Experience × Difficulty interaction (p=0.87). Brain-behavior correlations revealed a significant negative relationship between frontal theta and error in the experienced group for the difficult task (r=-0.594, p=0.0058), but no such relationship emerged for novices.

    Conclusion: We find frontal theta power differentiates between surgical experiences but correlates only with error rates for experienced surgeons while performing difficult tasks. These results provide a novel perspective on the relationship between expertise and surgical performance.

  9. Elangovan D, Long CS, Bakrin FS, Tan CS, Goh KW, Yeoh SF, et al.
    JMIR Med Inform, 2022 Jan 20;10(1):e17278.
    PMID: 35049516 DOI: 10.2196/17278
    BACKGROUND: Blockchain technology is a part of Industry 4.0's new Internet of Things applications: decentralized systems, distributed ledgers, and immutable and cryptographically secure technology. This technology entails a series of transaction lists with identical copies shared and retained by different groups or parties. One field where blockchain technology has tremendous potential is health care, due to the more patient-centric approach to the health care system as well as blockchain's ability to connect disparate systems and increase the accuracy of electronic health records.

    OBJECTIVE: The aim of this study was to systematically review studies on the use of blockchain technology in health care and to analyze the characteristics of the studies that have implemented blockchain technology.

    METHODS: This study used a systematic review methodology to find literature related to the implementation aspect of blockchain technology in health care. Relevant papers were searched for using PubMed, SpringerLink, IEEE Xplore, Embase, Scopus, and EBSCOhost. A quality assessment of literature was performed on the 22 selected papers by assessing their trustworthiness and relevance.

    RESULTS: After full screening, 22 papers were included. A table of evidence was constructed, and the results of the selected papers were interpreted. The results of scoring for measuring the quality of the publications were obtained and interpreted. Out of 22 papers, a total of 3 (14%) high-quality papers, 9 (41%) moderate-quality papers, and 10 (45%) low-quality papers were identified.

    CONCLUSIONS: Blockchain technology was found to be useful in real health care environments, including for the management of electronic medical records, biomedical research and education, remote patient monitoring, pharmaceutical supply chains, health insurance claims, health data analytics, and other potential areas. The main reasons for the implementation of blockchain technology in the health care sector were identified as data integrity, access control, data logging, data versioning, and nonrepudiation. The findings could help the scientific community to understand the implementation aspect of blockchain technology. The results from this study help in recognizing the accessibility and use of blockchain technology in the health care sector.

  10. Li H, Tang R, Mustapha WAW, Liu J, Hasan KMF, Li X, et al.
    Gels, 2021 Dec 27;8(1).
    PMID: 35049558 DOI: 10.3390/gels8010021
    Gelatin coating is an effective way to prolong the shelf life of meat products. Aiming at solving the problem of flavor deterioration during the storage of pork at room temperature, pork coating technology was developed to preserve the pork at 25 °C, and the comprehensive sensory analysis of vision, touch, smell, and taste was used to study the effect of coating on preservation of pork flavor. Herein, uncoated (control) and coated pork samples (including gelatin coating and gelatin coating incorporated with ginger essential oil) were analyzed to investigate the integrity of pork periodically during storage at 25 °C for weight loss, color, texture (springiness, chewiness, cohesiveness, gumminess, and hardness), microstructure, odor (electronic nose), taste (electronic tongue), volatile flavor substance, and taste ingredients. The results suggested that ginger essential oil (GEO) gelatin coating and gelatin coating can effectively inhibit the loss of water dispersion and slow down the oxidation reaction, coating treatments could significantly (p < 0.05) retarded the weight loss of pork slices, with values of 20.19%, 15.95%, 13.12% for uncoated, gelatin coated, and GEO-gelatin coated samples during 24 h of storage, respectively. Compared with control group, the color, texture, smell, and taste evaluations demonstrated that coating treatments had improved sensory and texture attributes during the storage period. Furthermore, the comprehensive results from the physical property assays (especially the texture), morphological assay and volatile odor assays showed that the GEO-fish gelatin composite coating had better preservation effect on pork flavor than the fish gelatin coating. The study suggests that the gelatin composite coating could be developed as a prospective active packaging to preserve pork meat at room temperature.
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