Browse publications by year: 2021

  1. Mohd Shahnaz Shamsuddin, Fredie Robinson, Safirah Jaan Jaafar, Syed Shajee Hussain, Than Myint
    Borneo Epidemiology Journal, 2021;2(1):45-51.
    MyJurnal
    Introduction: In the military, different aspects of job satisfaction are taken into account as compared to the civilian workforce. Some of the job satisfaction is related to as the working environment, nature of work and task, military operations and organizational traditions (e.g. obedience, policies and military disciplines). All these job stressors have an influence on the job satisfaction. Therefore, the military cannot be regarded as a normal and traditional work setting. The objectives of this study were to determine the differences of occupational stressors among submariners and surface ship personnel, the job satisfaction itself and to find a relationship between job satisfaction and occupational stressors among those two groups of occupation.
    Methods: In this cross-sectional comparative study, self-administered NIOSH (USA) Generic Job Stress Questionnaire was used as a tool to measure occupational stressors and job satisfaction among 50 submariners and 48 surface ship personnel.
    Results: The response rate was 98%. The result showed that there are statistically significant difference in the means in terms of job stressors among submariners and surface ship crews except for the conflict at work (P=0.03) and job requirement (P=0.01). Simple linear regression analysis shows that only mental demands had significant relationship with job satisfaction (P
  2. Marieanne Florence, Ateeqah Abdul Said, Jaya Dhaarshini Sundara Rajan, Karrthigeyan Ramachandaran, Muhamad Luqman Hakim Mohd Yamin, Nur Syahierra Azmi, et al.
    Borneo Epidemiology Journal, 2021;2(1):25-35.
    MyJurnal
    Introduction: Mitigation measures are important in curbing COVID-19 infection. However, people’s adherence to the control measures is depending upon their knowledge, attitudes and practices (KAP) towards the disease. This study aims to determine the KAP onCOVID-19 and its associated factors among medical students in Malaysian Borneo during the period of the pandemic. Methods: A cross-sectional online survey of 248 medical students from University Malaysia Sabah was conducted from August to September 2020. The survey instrument was adapted from a previously validated questionnaire on COVID-19. Descriptive statistics and simple logistic regression were conducted. Results: The mean age of respondents was 22.0 (SD 1.4) years. Majority (65.7%, n= 163) were clinical students, female gender (70.6%, n= 175), and Bumiputra ethnic (46.8%, n= 116). 211 (85.1%), 191 (77.0%) and 163 (65.7%) of the respondents have good level of knowledge, positive attitude and good practice respectively.Conclusion:The medical students are updated with the current health issues especially on COVID-19. They are aware of the attributes of the disease and have concerns in taking good care of themselves. Further study needs to be implemented among the groups of non-medical student of the same institution to compare their KAP on COVID-19.
  3. Narindeerjeet Kaur, Syed Sharizman Syed Abdul Rahim, Mohd Yusof Ibrahim, Mohd Azimullah Abdullah Zakaria
    Borneo Epidemiology Journal, 2021;2(1):36-44.
    MyJurnal
    Introduction: Dengue fever is endemic in Malaysia. It is a major public health challenge that has caused significant morbidity and mortality. A dengue outbreak is contributed by entomological factors, epidemiological and environmental factors. Outbreak response is crucial to reduce cases and death. This study is a descriptive dengue outbreak report in an urban residential area in Kota Kinabalu, Sabah Malaysia. Methods: This is a report of a dengue outbreak that started in middle of November 2019 and ended early December 2019. A dengue outbreak in Malaysia is defined when more than one dengue cases is reported in the same locality within 14 days from the date of notification of the first case. Cases were analysed descriptively looking at epidemiology and vector control database. Results: This outbreak involved 6 cases. The source reduction activities by elimination of breeding sites were conducted 3 times covering an area of 200-meter radius. A total of 110 premises were checked with coverageof 86%. The number of containers inspected was923, with 454 outside the premises and 469 inside the premises with no positive results for dengue larvae. Insecticide space spraying via thermal fogging was conducted with added ultra-low volume (ULV) spraying done within the 400 meterradius with coverageof 100%. Conclusion: Effective preventive measures have to be paired with responsible communities, as both play very vital roles in the control of dengue.
  4. Tan, Eric How Chee, Marilyn Maluda, Mohd Yusof Hj Ibrahim, Lim, Kai Joo, Aza Sherin Mohd Yusuff, Khamisah Awang Lukman
    MyJurnal
    Childhood undernutrition while being a preventable condition remains a major public health issue because it contributes to the mortality and morbidity of children globally. Intervention strategies to improve the nutritional status of children include therapeutic food, cash transfers, antibiotics and nutritional education. The objective is to review the effects of various nutritional interventions in addressing undernutrition in children. Methods: Comprehensive search of literature in electronic databases were conducted in PubMed, Science Direct, and Scopus containing the Medical Subject Headings (MeSH) and the title terms ‘Undernutrition’ OR ‘Malnutrition AND ‘Intervention’ OR ‘Management’ AND ‘Children’ OR ‘Childhood’ between January 2000 and August 2019. Of the 4358 studies that were identified, 17 studies matched the inclusion criteria and were reviewed. Results: Therapeutic food is an integral part of nutritional interventions in majority of the studies along with cash transfers and nutritional education. The most consistent outcome in most of the studies was improvement in the nutritional status which subsequently reduces the undernutrition in children. Conclusion: Therapeutic food, conditional cash transfer and nutritional education yielded the best outcome in alleviating undernutrition in developing countries.
  5. Er HM, Nadarajah VD, Chen YS, Misra S, Perera J, Ravindranath S, et al.
    Med Teach, 2021 Jul;43(sup1):S12-S17.
    PMID: 31522577 DOI: 10.1080/0142159X.2019.1659942
    Outcome-based education (OBE) has brought along a significant development in health professions education in the past decade. The shift from a process-driven to product-driven model of education is valuable for ensuring graduate quality and facilitating global movement of healthcare workers. Such a model can align the expectations of key stakeholders in an era of rapid knowledge expansion and technological advancement. Nevertheless, the experienced benefits of OBE depend on the effectiveness of its implementation. This article therefore provides practical tips and strategies for implementing OBE in order to maximize its potential.
    MeSH terms: Education, Medical*; Educational Status; Health Occupations*; Health Personnel/education; Humans; Knowledge
  6. Hasan A, Jannat K, Bondhon TA, Jahan R, Hossan MS, de Lourdes Pereira M, et al.
    PMID: 34376138 DOI: 10.2174/1871526521666210729164054
    OBJECTIVE: To evaluate the efficacy of reported anti-malarial phytochemicals as lead compounds for possible drug development against COVID-19.

    METHODS: An in silico approach was used in this study to determine through molecular docking the binding affinities and site of binding of these phytochemicals to the 3C-like protease of COVID-19 which is considered as the main protease of the virus.

    RESULTS: A number of anti-malarial phytochemicals like apigenin-7-O-glucoside, decurvisine, luteolin-7-O-glucoside, sargabolide J, and shizukaols A, B, F, and G showed predicted high binding energies with G values of -8.0 kcal/mol or higher. Shizukaols F and B demonstrated the best binding energies of -9.5 and -9.8, respectively. The acridone alkaloid 5-hydroxynoracronycine also gave a predicted high binding energy of -7.9 kcal/mol.

    CONCLUSION: This is for the first time that decursivine and several shizukaols were reported as potential anti-viral agents. These compounds merit further studies to determine whether they can be effective drug candidates against COVID-19.

  7. Faruque MRI, Siddiky AM, Ahamed E, Islam MT, Abdullah S
    Sci Rep, 2021 Aug 10;11(1):16247.
    PMID: 34376734 DOI: 10.1038/s41598-021-95468-8
    The electromagnetic properties of the metal based dielectric in the field of millimeter and sub-millimeter technology attracts a new era for innovation. In this research work, we have introduced a parallel LC shaped metamaterial resonator with wider bandwidth. The negative refractive index for two resonant frequencies is located from the negative permittivity from 5.1 to 6.3, 10.4 to 12.9 GHz, where the negative refractive index is located from 5.4 to 6.3 and 10.5 to 13.5 GHz. The electromagnetic wave polarizing in the proposed structure with parallel LC shaped metallic structure shows a fascinating response of wider bandwidth for the external electric and magnetic field. This paper focuses on the design of conducting layer for the suggested design with the parallel metallic arm for analysing the mutual coupling effect of the scattering response where the sub-branch in metallic design is shown more resonant frequencies with the enhancement of the compactness. This proposed structure is analysed with different metallic arrangements and array structures for different boundary conditions.
  8. Samsulrizal NH, Khadzran KS, Meenakshi Sundram TC, Zainuddin Z, Shaarani SHN, Azmi NSA, et al.
    Turk J Biol, 2021;45(3):314-322.
    PMID: 34377055 DOI: 10.3906/biy-2103-3
    Stevia rebaudiana is a medicinal plant recommended to diabetic or obese patients as an alternative sweetener owing to its low-calorie property. Previous studies have found that the stevioside level is highest at the time of flower bud formation and lowest at the time of preceding and following flower bud formation. Hence, this study aims to identify the genes involved in the flowering of local S. rebaudiana accession MS007 by investigating the transcriptomic data of two stages of growth, before flowering (BF) and after flowering (AF) that were deposited under accession number SRX6362785 and SRX6362784 at the NCBI SRA database. The transcriptomic study managed to annotate 108299 unigenes of S. rebaudiana with 8871 and 9832 genes that were differentially expressed in BF and AF samples, respectively. These genes involved in various metabolic pathways related to flower development, response to stimulus as well as photosynthesis. Pheophorbide A oxygenase ( PAO ), eukaryotic translation initiation factor 3 subunit E ( TIF3E1 ), and jasmonate ZIM domain-containing protein 1 ( JAZ1 ) were found to be involved in the flower development. The outcome of this study will help further research in the manipulation of the flowering process, especially in the breeding programme to develop photo-insensitive Stevia plant.
  9. Zolkafli SH, Ithnin M, Chan KL, Zainol Abidin MI, Ismail I, Ting NC, et al.
    Breed Sci, 2021 Apr;71(2):253-260.
    PMID: 34377073 DOI: 10.1270/jsbbs.19022
    Oil palm is continually being improved via controlled crossing of selected palms to ensure sustainable yields and productivity. As such, correct parental assignment is important as the presence of illegitimates will compromise the progress of improvement. In the present study, we determined the optimal number of microsatellite (SSR) markers for detection of illegitimates in selected oil palm crosses with high confidence. Determining the optimal number of markers to assign parentage will ensure that the DNA fingerprinting will be cost effective for routine use as a quality control tool in oil palm improvement programs. Here, we evaluated a wide range of crosses that included a cross derived from wild germplasm palm. The results revealed that markers with high PIC are informative and detect most of the alleles present in a cross, including those exhibited by the illegitimates. A larger number of optimum sets of markers are needed to detect all illegitimates for crosses with higher levels of genetic diversity. The optimal number of polymorphic SSR markers determined in the present study can ensure that appropriate quality control is implemented for oil palm improvement programs.
  10. Saraniti C, Chianetta E, Greco G, Mat Lazim N, Verro B
    Int Arch Otorhinolaryngol, 2021 Jul;25(3):e471-e478.
    PMID: 34377187 DOI: 10.1055/s-0040-1719119
    Introduction  Narrow-band imaging is an endoscopic diagnostic tool that, focusing on superficial vascular changes, is useful to detect suspicious laryngeal lesions, enabling their complete excision with safe and tailored resection margins. Objectives  To analyze the applications and benefits of narrow-band imaging in detecting premalignant and malignant laryngeal lesions through a comparison with white-light endoscopy. Data Synthesis  A literature search was performed in the PubMed, Scopus and Web of Science databases using strict keywords. Then, two authors independently analyzed the articles, read the titles and abstracts, and read completely only the relevant studies according to certain eligibility criteria. In total, 14 articles have been included in the present review; the sensitivity, specificity, positive and negative predictive values, and accuracy of pre- and/or intraoperative narrow-band imaging were analyzed. The analysis showed that narrow-band imaging is better than white-light endoscopy in terms of sensitivity, specificity, positive and negative predictive values, and accuracy regarding the ability to identify cancer and/or precancerous laryngeal lesions. Moreover, the intraoperative performance of narrow-band imaging resulted more effective than the in-office performance. Conclusion  Narrow-band imaging is an effective diagnostic tool to detect premalignant and malignant laryngeal lesions and to define proper resection margins. Moreover, narrow-band imaging is useful in cases of leukoplakia that may cover a possible malignant lesion and that cannot be easily assessed with white-light endoscopy. Finally, a shared, simple and practical classification of laryngeal lesions, such as that of the European Laryngological Society, is required to identify a shared lesion management strategy. Key Points Narrow-band imaging is useful in detecting suspicious laryngeal lesions and proper resection margins showing intraepithelial papillary capillary loops (IPCLs) that are considered a main cancer feature.Narrow-band imaging is used both pre- and intraoperatively, but it provides more precise information if used during surgery.Compared with white-light endoscopy, narrow-band imaging enables a better assessment of the lesions covered by a thick white plaque (such as in cases of leukoplakia)The classification of the European Laryngological Society is the simplest and the most practical for the identification of various laryngeal lesions compared with other classifications.
  11. Thong HK, Sugumaran V, Mohamad Mahbob HB, Tengku Kamalden TMIB
    J Med Life, 2021 8 12;14(3):419-423.
    PMID: 34377211 DOI: 10.25122/jml-2020-0061
    Thromboses of the upper extremity and neck are rare and not as commonly seen as lower extremity deep vein thrombosis (DVT). Internal jugular vein thrombosis (IJVT) is a serious condition with a potentially fatal outcome. Jugular vein thrombosis refers to the formation of intraluminal thrombi anywhere from the intracranial part of the jugular vein to the junction between the internal jugular vein (IJV) and subclavian vein. The relationship between malignancy and thromboembolic disorders has been well established, as Trousseau first described it in 1865. Tumor cells are known to promote hypercoagulability by expressing tissue factors that activate clotting cascades and procoagulants while promoting interactions between the tumor cells, platelets, and endothelial cells via different cytokines, tumor antigens, and their immune complexes. We are reporting our encounter with a patient who presented with extensive left internal jugular vein thrombosis as the first presenting sign of primary lung malignancy.
    MeSH terms: Adult; Carcinoma*; Female; Humans; Lung; Vena Cava, Superior; Endothelial Cells
  12. Abdullah S, Chia Hua L, Sheau Yun L, Thavamany Devapitchai AS, Ahmad AA, Narin Singh PSG, et al.
    Cureus, 2021 Jul;13(7):e16269.
    PMID: 34377605 DOI: 10.7759/cureus.16269
    Background The Wide-Awake-Local-Anaesthesia-No-Tourniquet (WALANT) technique achieves an almost bloodless field for clear visualization during surgeries. WALANT utilizes lidocaine and epinephrine for anesthesia and hemostasis, respectively, without the usage of sedation and tourniquet. This avoids the potential side effects of tourniquet-related pain and sedation-related complications. However, acceptance is still low due to concerns regarding the safety of epinephrine injection in the finger. There is a persistent belief that epinephrine can cause digital ischemia. Purpose To evaluate retrospectively possible complications of hand surgeries performed using the WALANT technique. Methods All finger and hand procedures performed under the WALANT technique from June 2016 to May 2021 in an urban tertiary hospital were studied retrospectively. Results There were a total of 1073 cases, of which 694 were females and 379 were males. The mean age was 55 years. Finger surgeries (e.g., trigger finger release, excision of finger lesions, removal of implants) consisted of 707 cases; and the rest (366 cases) were hand surgeries (e.g., carpal tunnel release, excision of hand lesions, removal of implants). In all cases reviewed, there were no instances of circulatory compromise. There were also no circumstances where usage of reversal with phentolamine is recorded. Conclusion We believe that performing finger and hand surgeries using the WALANT technique is safe and beneficial. The usage of WALANT in hand surgeries avoids tourniquet pain. However, WALANT should be used with caution in those with vascular insufficiency or disease.
  13. Pang NTP, Kamu A, Mohd Kassim MA, Ho CM
    Infect Dis Model, 2021;6:898-908.
    PMID: 34377875 DOI: 10.1016/j.idm.2021.07.004
    Introduction: COVID-19 has affected almost every country in the world, which causing many negative implications in terms of education, economy and mental health. Worryingly, the trend of second or third wave of the pandemic has been noted in multiple regions despite early success of flattening the curve, such as in the case of Malaysia, post Sabah state election in September 2020. Hence, it is imperative to predict ongoing trend of COVID-19 to assist crucial policymaking in curbing the transmission.

    Method: Generalized logistic growth modelling (GLM) approach was adopted to make prediction of growth of cases according to each state in Malaysia. The data was obtained from official Ministry of Health Malaysia daily report, starting from 26 September 2020 until 1 January 2021.

    Result: Sabah, Johor, Selangor and Kuala Lumpur are predicted to exceed 10,000 cumulative cases by 2 February 2021. Nationally, the growth factor has been shown to range between 0.25 to a peak of 3.1 throughout the current Movement Control Order (MCO). The growth factor range for Sabah ranged from 1.00 to 1.25, while Selangor, the state which has the highest case, has a mean growth factor ranging from 1.22 to 1.52. The highest growth rates reported were in WP Labuan for the time periods of 22 Nov - 5 Dec 2020 with growth rates of 4.77. States with higher population densities were predicted to have higher cases of COVID-19.

    Conclusion: GLM is helpful to provide governments and policymakers with accurate and helpful forecasts on magnitude of epidemic and peak time. This forecast could assist government in devising short- and long-term plan to tackle the ongoing pandemic.

  14. Samy AL, Hairi NN, Low WY
    FASEB Bioadv, 2021 Aug;3(8):593-600.
    PMID: 34377955 DOI: 10.1096/fba.2020-00115
    Type II Diabetes Mellitus (T2DM) is a serious public health issue, affecting the global population, particularly those living in low- and middle-income countries. Worldwide, the prevalence of T2DM ranges between 10.4% and 13.5%, depending on the domiciliary. T2DM negatively affects individuals' quality of life and causes high economic burden due to the increasing cost of treatment and management of the disease. Risk factors associated with T2DMs include aging, lifestyle or behavior, genetics, and important biopsychological aspects, which are psychological stress and sleep deprivation. By understanding the associations of psychological stress and sleep deprivation, which contribute to pathophysiology of T2DM, policies, programs, and guidelines were developed in Malaysia to combat the issue among population at large. This narrative review examines 19 national public health policies, programs, and guidelines from the past 20 years in Malaysia that aimed to mitigate the negative health effects of psychological stress, sleep deprivation, and T2DM, both from the government and non-governmental organizations. Both psychological stress and sleep deprivation works independently or as combined effects in the pathophysiology of T2DM. Besides, in Malaysia, the government, in collaboration with non-governmental organizations, have been developing and implementing policies, programs, and guidelines to combat mental health and T2DM issues, targeted to population at large. Integration of digital technology, such as usage of social media for health promotion and dissemination of public health messages to the community and good governance from government were deemed important in the effective implementation of health policies and guidelines, resulting in better health outcome.
  15. Halim FS, Parmin NA, Hashim U, Gopinath SCB, Dahalan FA, Zakaria II, et al.
    PMID: 34378814 DOI: 10.1002/bab.2239
    An oligonucleotide DNA probe has been developed for the application in the DNA electrochemical biosensor for the early diagnosis of coronavirus disease (COVID-19). Here, the virus microRNA from the N-gene of severe acute respiratory syndrome-2 (SARS-CoV-2) was used for the first time as a specific target for detecting the virus and became a framework for developing the complementary DNA probe. The sequence analysis of the virus microRNA was carried out using bioinformatics tools including basic local alignment search tools, multiple sequence alignment from CLUSTLW, microRNA database (miRbase), microRNA target database, and gene analysis. Cross-validation of distinct strains of coronavirus and human microRNA sequences was completed to validate the percentage of identical and consent regions. The percent identity parameter from the bioinformatics tools revealed the virus microRNAs' sequence has a 100% match with the genome of SARS-CoV-2 compared with other coronavirus strains, hence improving the selectivity of the complementary DNA probe. The 30 mer with 53.0% GC content of complementary DNA probe 5' GCC TGA GTT GAG TCA GCA CTG CTC ATG GAT 3' was designed and could be used as a bioreceptor for the biosensor development in the clinical and environmental diagnosis of COVID-19.
  16. Khoo BP, Chew KT, Hing EY, Kampan N, Shafiee MN
    Horm Mol Biol Clin Investig, 2021 Aug 10;42(4):429-433.
    PMID: 34378876 DOI: 10.1515/hmbci-2021-0025
    OBJECTIVES: Endometrial cancer is the sixth most common cancer among women and recurrence of after 10 years is extremely rare.

    CASE PRESENTATION: We reported a comprehensive review of histopathology, investigations and treatment regarding a woman with distant recurrence of endometrial cancer to rectus abdominis muscle after 23 years from the primary surgery. Previous published literatures of similar case were included into the review analysis. A total of 11 similar cases had been reported. Overall, 9 (81.8%) cases were stage 1 disease and only 2 cases were classified as stage II disease. The majority, 6 (54.5%) cases were endometrial adenocarcinoma. Majority of the cases shared the similarity of low grade endometrial cancer with positive oestrogen receptor immunophynetype.

    CONCLUSIONS: Thus, the phenomenon of 'cell dormancy' was hypothesized to explain the mechanism of late recurrence for these cases.

  17. Ross PA, Gu X, Robinson KL, Yang Q, Cottingham E, Zhang Y, et al.
    Appl Environ Microbiol, 2021 09 28;87(20):e0126421.
    PMID: 34379518 DOI: 10.1128/AEM.01264-21
    Aedes mosquitoes harboring intracellular Wolbachia bacteria are being released in arbovirus and mosquito control programs. With releases taking place around the world, understanding the contribution of host variation to Wolbachia phenotype is crucial. We generated a Wolbachia transinfection (wAlbBQ) in Aedes aegypti and performed backcrossing to introduce the infection into Australian or Malaysian nuclear backgrounds. Whole Wolbachia genome sequencing shows that the wAlbBQ transinfection is nearly identical to the reference wAlbB genome, suggesting few changes since the infection was first introduced to A. aegypti over 15 years ago. However, these sequences were distinct from other available wAlbB genome sequences, highlighting the potential diversity of wAlbB in natural Aedes albopictus populations. Phenotypic comparisons demonstrate the effects of wAlbB infection on egg hatching and nuclear background on fecundity and body size but no interactions between wAlbB infection and nuclear background for any trait. The wAlbB infection was stable at high temperatures and showed perfect maternal transmission and cytoplasmic incompatibility regardless of the host background. Our results demonstrate the stability of wAlbB across host backgrounds and point to its long-term effectiveness for controlling arbovirus transmission and mosquito populations. IMPORTANCE Wolbachia bacteria are being used to control the transmission of dengue virus and other arboviruses by mosquitoes. For Wolbachia release programs to be effective globally, Wolbachia infections must be stable across mosquito populations from different locations. In this study, we transferred Wolbachia (strain wAlbB) to Aedes aegypti mosquitoes with an Australian genotype and introduced the infection to Malaysian mosquitoes through backcrossing. We found that the phenotypic effects of Wolbachia are stable across both mosquito backgrounds. We sequenced the genome of wAlbB and found very few genetic changes despite spending over 15 years in a novel mosquito host. Our results suggest that the effects of Wolbachia infections are likely to remain stable across time and host genotype.
  18. Bramantoro T, Santoso CMA, Hariyani N, Setyowati D, Zulfiana AA, Nor NAM, et al.
    PLoS One, 2021;16(8):e0256007.
    PMID: 34379685 DOI: 10.1371/journal.pone.0256007
    BACKGROUND: Schools offer an opportunity for oral health promotion in children and adolescents. The purpose of this study was to conduct a systematic review of the influence of school-based oral health promotion programmes on oral health knowledge (OHK), behaviours (OHB), attitude (OHA), status (OHS), and quality of life (OHRQoL) of children and adolescents.

    METHODS: A systematic search on the PubMed and Embase databases was conducted to identify eligible studies. The last search was done on April 24th, 2020. The quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools.

    RESULTS: Of the 997 articles identified, 31 articles were included in this review. Seven studies targeted students in preschools, seventeen in elementary schools, and seven in high schools. Most of these studies revealed positive outcomes. Some studies showed that the school-based oral health promotion programmes showed better OHK, OHB, OHS, and OHRQoL.

    CONCLUSION: Positive results were obtained through oral health promotion programmes in schools, especially those involving children, teachers, and parents.

  19. Nordin FJ, Pearanpan L, Chan KM, Kumolosasi E, Yong YK, Shaari K, et al.
    PLoS One, 2021;16(8):e0256012.
    PMID: 34379689 DOI: 10.1371/journal.pone.0256012
    Triple-negative breast cancer is the main type of breast carcinoma that causes mortality among women because of the limited treatment options and high recurrence. Chronic inflammation has been linked with the tumor microenvironment (TME) in breast cancer progression. Clinacanthus nutans (CN) has gained much attention because of its anticancer properties, but its mechanism remains unclear. We aimed to study the qualitative phytochemical content and elucidate the cytotoxicity effects of CN on human triple-negative breast cancer (TNBC), MDA-MB-231 and human macrophage-like cells such as THP-1 by using sulforhodamine B (SRB) assay. As highly metastatic cells, MDA-MB-231 cells can migrate to the distal position, the effect of CN on migration were also elucidated using the scratch assay. The CN effects on ameliorating chronic inflammation in TME were studied following the co-culture of MDA-MB-231/THP-1 macrophages. The cytokine expression levels of IL-6, IL-1β and tumor necrosis factor-alpha (TNF-α) were determined using ELISA assays. The results showed that both ethanolic and aqueous CN extracts contained alkaloid, phenol and tannin, flavonoid, terpenoid, glycoside and steroid. However, saponin was only found in the aqueous extract of CN. CN was not cytotoxic to both MDA-MB-231 and THP-1 cells. The ability of MDA-MB-231 to migrate was also not halted by CN treatment. However, CN ethanol extract decreased IL-6 at 25 μg/mL (p = 0.02) and 100 μg/mL (p = 0.03) but CN aqueous extract increased IL-6 expression at 50 μg/mL (p = 0.08) and 100 μg/mL (p = 0.02). IL-1β showed decreased expression after treated with CN ethanol and CN aqueous both at 25 μg/mL (p = 0.03). TNF-α were significantly decreased after CN ethanol treatment at concentration 25- (p = 0.001), 50- (p = 0.000) and 100 μg/mL (p = 0.000). CN aqueous extract slightly inhibited TNF-α at all 25-50- and 100 μg/mL (p = 0.001, p = 0.000, p = 0.000, respectively). Overall, CN acts by ameliorating the pro-inflammatory condition in the TME and may be a potential strategy for its anticancer mechanism on highly metastatic breast cancer condition. The major pathways that link both cancer and inflammation were NF-κB and STATs thus further study on the upstream and downstream pathways is needed to fully understand the mechanism of CN extracts in cooling the inflamed TME in breast cancer.
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