Browse publications by year: 2024

  1. Abu Hammour A, Hammour KA, Alhamad H, Nassar R, El-Dahiyat F, Sawaqed M, et al.
    J Pharm Policy Pract, 2024;17(1):2429000.
    PMID: 39600801 DOI: 10.1080/20523211.2024.2429000
    BACKGROUND: The integration of Artificial Intelligence (AI) tools like ChatGPT into medical education is expanding, offering benefits such as efficient information synthesis. However, concerns about the accuracy, reliability, and proper use of these tools persist. Understanding medical students' perceptions of ChatGPT is crucial for optimising its use in educational settings.

    OBJECTIVES: To evaluate how medical students perceive ChatGPT for educational purposes and to assess its perceived advantages and disadvantages.

    METHODS: A cross-sectional study was carried out using a questionnaire with five main domains to explore Jordanian medical students' perceptions, practices, and concerns regarding the ChatGPT. This study was conducted from May to July, 2023, and the data were collected using the convenience sampling technique through Google Forms shared within medical students' Facebook groups. Descriptive statistics summarised participant demographics, while logistic regression identified factors influencing ChatGPT usage. Variables with a P-value ≤ 0.05 in multiple regression were considered statistically significant.

    RESULTS: Nearly two-thirds (N = 136, 61.5%) claimed to have knowledge of AI but not in clinical settings. Most participants (88.5%, N = 216) were aware of ChatGPT, with 86.9% (N = 212) agreeing that 'Medical students can benefit from using ChatGPT.' Additionally, 83.2% (N = 203) felt that 'ChatGPT helps students quickly and easily summarize complex information.' Conversely, 78.3% (N = 191) expressed concerns about ChatGPT's potential inaccuracies, with accuracy and reliability cited as primary concerns. Multiple logistic regression showed that younger students (OR = 0.902, P = 0.025) and those with lower proficiency (OR = 0.487, P = 0.007) used ChatGPT more frequently than others.

    CONCLUSION: Although the use of the ChatGPT could be more beneficial for aiding students in developing medical knowledge, evidence-based academic regulations should guide its use. Future research should be conducted to examine the enablers and barriers to ChatGPT use in medical education.

  2. Koh HP, Nagarajah JR, Hassan H, Ross NT
    World J Emerg Med, 2024;15(6):433-440.
    PMID: 39600808 DOI: 10.5847/wjem.j.1920-8642.2024.077
    BACKGROUND: Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents. This study aimed to determine the incidence, characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction (STEMI) thrombolysis in an Asian population.

    METHODS: This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital. Total population sampling was used in this study. The primary outcome was bleeding events post-thrombolysis, categorised using the Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria. Inferential statistics were used to determine the associations between relevant variables.

    RESULTS: Data from 941 patients were analysed. A total of 156 (16.6%) STEMI patients bled post-thrombolysis. Major, minor, and minimal TIMI occurred in 7 (0.7%), 17 (1.8%), and 132 (14.0%) patients, respectively. Age 65 years (P=0.031) and Malaysian Chinese (P=0.008) were associated with a higher incidence of bleeding post-thrombolysis. Conversely, foreigners (P=0.032) and current smoker (P=0.007) were associated with a lower incidence of bleeding. Both TIMI major (P<0.001) and TIMI minor (P<0.001) were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients. TIMI minor bleeding was significantly higher in the streptokinase recipients. The bleeding sites were comparable between streptokinase and tenecteplase recipients, except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients (P=0.027).

    CONCLUSION: In our Asian population, the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported. The development of TIMI major and minor bleeding complications is associated with higher mortality.

  3. Mahyudin NAA, Fauzi NA, Munian K
    Biodivers Data J, 2024;12:e137367.
    PMID: 39600938 DOI: 10.3897/BDJ.12.e137367
    The Permanent Forest Reserve (PFR) is recognised as one of the Environmentally Sensitive Areas (ESAs) in Malaysia`s spatial planning. Incorporating biological factors alongside existing physical attributes is crucial to improve the classification of ESAs. It is important to attain biological diversity information to formulate biological factors, which include vertebrates such as bird communities. Birds are highly sensitive to changes within ecosystems; hence, they play a pivotal role in reflecting the overall ecological condition. Therefore, the study focused on assessing bird species' richness in the Kluang Forest Reserve (Kluang FR) and compared its bird diversity amongst five PFRs ESAs in southern Peninsular Malaysia. Methods such as mist netting, point count observations and call recording were deployed to calculate the alpha and beta diversity of the bird community. A total of 68 species comprised of 36 families were recorded and the white-rumped shama (Copsychusmalabaricus) was the most abundant species in all reserves studied. Principal Coordinates Analysis (PCoA) revealed that the bird diversity in Kluang FR is more similar to bird santuary Panti Forest Reserve compared to the other four forest reserves and indicates that diversification of species richness. However, the absence of published species information in forest reserves poses challenges for comparing bird assemblages amongst different reserves. More extensive studies are needed in Johor and throughout Malaysia to provide data that can effectively assist and support biodiversity conservation and management.
  4. Dong Y, Badrin S, Badrin S, Tang L
    Belitung Nurs J, 2024;10(6):601-613.
    PMID: 39601026 DOI: 10.33546/bnj.3526
    BACKGROUND: Fatigue following a stroke, known as post-stroke fatigue (PSF), is a frequent complication experienced by individuals recovering from a stroke, with its incidence steadily increasing over time. The long-term presence of PSF significantly hinders the rehabilitation process and quality of life for these individuals. However, the most effective intervention strategies for PSF remain unclear. Therefore, it is crucial to implement appropriate intervention strategies at an early stage to prevent and manage PSF, thereby mitigating its negative impacts and promoting recovery in stroke survivors.

    OBJECTIVE: This scoping review aimed to explore and chart the interventions available for managing post-stroke fatigue in individuals recovering from stroke, providing healthcare professionals with evidence to guide the development of optimal treatments.

    DESIGN: A scoping review.

    DATA SOURCES: This review conducted a systematic search across six databases⎯PubMed, Web of Science, Cochrane Library, Scopus and CINAHL (via EBSCO), and CNKI, for articles published from 10 January 2012 to early May 2024.

    REVIEW METHODS: This review followed the PRISMA-ScR reporting guidelines. Studies were selected based on the PCC framework, focusing on specific participants, concepts, and contexts. Exclusion criteria included ongoing studies without results, articles without full text, posters, reviews, and protocols. Tables and narrative descriptions were used to present relevant information on the interventions and their outcomes during the review process.

    RESULTS: Twenty-seven studies were included, categorizing interventions for post-stroke fatigue into ten types: pharmacological treatments, physical activity, physical therapy, cognitive behavioral therapy, respiratory training, music therapy, mindfulness-based stress reduction, health education management, Traditional Chinese Medicine, and environmental enrichment.

    CONCLUSION: The interventions for post-stroke fatigue have demonstrated positive effects in alleviating fatigue symptoms among stroke survivors. However, some approaches have limitations, and the most effective treatment strategy remains unclear. The multidisciplinary collaboration between nurses and healthcare professionals plays a critical role in managing post-stroke fatigue by providing patients with education on fatigue prevention and treatment, along with personalized care plans, including one-on-one or group interventions. Future research should focus on increasing sample sizes and conducting multicenter trials to identify the most effective intervention strategies for managing post-stroke fatigue.

  5. Hussein M, Hassan A, Nada MAF, Mohammed Z, Fathy W, Abdel Ghaffar NF, et al.
    Headache, 2024 Nov 27.
    PMID: 39601107 DOI: 10.1111/head.14874
    BACKGROUND: The Migraine-Specific Quality-of-Life Questionnaire version 2.1 (MSQ 2.1) is one of the most frequently used tools in assessing the impact of migraine in clinical practice and in migraine research. This work aimed to examine the reliability and validity of the Arabic version of the MSQ 2.1 in Arabic-speaking patients with migraine and to assess its ability to detect subtle changes in quality of life after receiving prophylactic migraine medications.

    METHODS: This multicenter prospective observational study was conducted with 140 patients experiencing migraine and indicated for prophylactic medications. Headache assessment was done at baseline and 3 months after receiving prophylactic medications using the Arabic version of MSQ 2.1, Headache Impact Test (HIT-6), and visual analog scale (VAS). The MSQ 2.1 was repeated 1 week after the first visit to a group of patients (n = 70) to assess test-retest reliability.

    RESULTS: Cronbach's alpha for the MSQ 2.1 was 0.973, indicating excellent internal consistency. The intraclass correlation coefficient (average measure) was 0.99, indicating excellent test-retest reliability. There were statistically significant correlations between the MSQ 2.1 total score and monthly migraine days, VAS, and HIT-6 scores before and 3 months after prophylactic medications. The receiver operating characteristic curve revealed that an increase of 8.5 in the total score of the MSQ 2.1 represents the minimally important change that means significant improvement (area under the curve = 0.785, sensitivity = 0.861, specificity = 0.656, p 

  6. Caballero-Ávila M, Martín-Aguilar L, Pascual-Goñi E, Michael MR, Koel-Simmelink MJA, Höftberger R, et al.
    Ann Neurol, 2024 Nov 27.
    PMID: 39601182 DOI: 10.1002/ana.27142
    OBJECTIVE: To analyze long-term clinical and biomarker features of anti-contactin-1 (CNTN1) autoimmune nodopathy (AN).

    METHODS: Patients with anti-CNTN1+ autoimmune nodopathy detected in our laboratory from which clinical information was available were included. Clinical features and treatment response were retrospectively collected. Autoantibody, serum neurofilament light chain (sNfL), and serum CNTN1 levels (sCNTN1) were analyzed at baseline and follow up.

    RESULTS: A total of 31 patients were included. Patients presented with progressive sensory motor neuropathy (76.7%) with proximal (74.2%) and distal involvement (87.1%), ataxia (71.4%), and severe disability (median INCAT at nadir of 8). A total of 11 patients (35%) showed kidney involvement. Most patients (97%) received intravenous immunoglobulin, but only 1 achieved remission with intravenous immunoglobulin. A total of 22 patients (71%) received corticosteroids, and 3 of them (14%) did not need further treatments. Rituximab was effective in 21 of 22 patients (95.5%), with most of them (72%) receiving a single course. Four patients (12.9%) relapsed after a median follow up of 25 months after effective treatment (12-48 months). Anti-CNTN1 titers correlated with clinical scales at sampling and were negative after treatment in all patients, but 1 (20/21). sNfL levels were significantly higher and sCNTN1 significantly lower in anti-CNTN1+ patients than in healthy controls (sNfL: 135.9 pg/ml vs 7.48 pg/ml, sCNTN1: 25.03 pg/ml vs 22,186 pg/ml, p 

  7. Winter AJ, de Courcy-Ireland F, Phillips AP, Barker JM, Bakar NA, Akter N, et al.
    Angew Chem Int Ed Engl, 2024 Dec 02;63(49):e202410502.
    PMID: 39105412 DOI: 10.1002/anie.202410502
    The delineation of the complex biosynthesis of the potent antibiotic mupirocin, which consists of a mixture of pseudomonic acids (PAs) isolated from Pseudomonas fluorescens NCIMB 10586, presents significant challenges, and the timing and mechanisms of several key transformations remain elusive. Particularly intriguing are the steps that process the linear backbone from the initial polyketide assembly phase to generate the first cyclic intermediate PA-B. These include epoxidation as well as incorporation of the tetrahydropyran (THP) ring and fatty acid side chain required for biological activity. Herein, we show that the mini-module MmpE performs a rare online (ACP-substrate) epoxidation and is integrated ('in-cis') into the polyketide synthase via a docking domain. A linear polyketide fragment with six asymmetric centres was synthesised using a convergent approach and used to demonstrate substrate flux via an atypical KS0 and a previously unannotated ACP (MmpE_ACP). MmpE_ACP-bound synthetic substrates were critical in demonstrating successful epoxidation in vitro by the purified MmpE oxidoreductase domain. Alongside feeding studies, these results confirm the timing as well as chain length dependence of this selective epoxidation. These mechanistic studies pinpoint the location and nature of the polyketide substrate prior to the key formation of the THP ring and esterification that generate PA-B.
    MeSH terms: Epoxy Compounds/metabolism; Epoxy Compounds/chemistry; Polyketide Synthases/metabolism
  8. Valdez J, Damasceno G, Oh RRY, Quintero Uribe LC, Barajas Barbosa MP, Amado TF, et al.
    Conserv Biol, 2024 Dec;38(6):e14325.
    PMID: 39105487 DOI: 10.1111/cobi.14325
    Biodiversity research is essential for addressing the global biodiversity crisis, necessitating diverse participation and perspectives of researchers from a wide range of backgrounds. However, conservation faces a significant inclusivity problem because local expertise from biodiversity-rich but economically disadvantaged regions is often underrepresented. This underrepresentation is driven by linguistic bias, undervalued contributions, parachute science practices, and capacity constraints. Although fragmented solutions exist, a unified multistakeholder approach is needed to address the interconnected and systemic conservation issues. We devised a holistic framework of collective responsibility across all research participants and tailored strategies that embrace diversity and dismantle systemic barriers to equitable collaboration. This framework delineates the diverse actors and practices required for promoting inclusivity in biodiversity research, assigning clear responsibilities to researchers, publishers, institutions, and funding bodies. Strategies for researchers include cultivating self-awareness, expanding literature searches, fostering partnerships with local experts, and promoting knowledge exchange. For institutions, we recommend establishing specialized liaison roles, implementing equitable policies, allocating resources for diversity initiatives, and enhancing support for international researchers. Publishers can facilitate multilingual dissemination, remove financial barriers, establish inclusivity standards, and ensure equitable representation in peer review. Funders must remove systemic barriers, strengthen research networks, and prioritize equitable resource allocation. Implementing these stakeholder-specific strategies can help dismantle deep-rooted biases and structural inequities in biodiversity research, catalyzing a shift toward a more inclusive and representative model that amplifies diverse perspectives and maximizes collective knowledge for effective global conservation.
    MeSH terms: Research; Biodiversity*
  9. Masura SS, Shaharuddin NA, Masani MYA, Chan KL, Low EL, Chan PL, et al.
    Transgenic Res, 2024 Oct;33(5):383-397.
    PMID: 39120800 DOI: 10.1007/s11248-024-00396-8
    Root-specific or preferential promoters are essential to genetically modify plants with beneficial root traits. We have characterised the promoter from an oil palm metallothionein gene (EgMT) and performed a serial 5' deletion analysis to identify the region(s) essential for transgenes expression in roots. Stable functional characterisation of tobacco transgenic lines using the T1 generation showed that a deletion construct, designated as RSP-2D (1107 bp), directed strong GUS expression at all stages of root development, particularly in mature roots. Other constructs, RSP-2A (2481 bp) and RSP-2C (1639 bp), drove GUS expression in roots with an intensity lower than RSP-2D. The promoter activity was also detectable in seed pods and immature seeds, albeit at lower levels than CaMV35S. The promoter activity may also be induced by wounding as intact GUS staining was observed at the flower- and leaf-cutting sites of T1 samples carrying either RSP-2C or RSP-2D constructs. The promoter sequence contains cis-acting elements that may act as negative regulators and be responsible for root specificity. The results further indicated that the 5' UTR and ATATT sequences are essential for strong promoter activity. This study highlights the potential of RSP-2D promoter as a tool for modifying root traits through genetic engineering.
    MeSH terms: Plant Proteins/genetics; Promoter Regions, Genetic*; Gene Expression Regulation, Plant*; Arecaceae/genetics; Arecaceae/growth & development
  10. Zhang X, Wang J, Xiang S, Zhao L, Lv M, Duan Y, et al.
    Am J Chin Med, 2024;52(6):1795-1817.
    PMID: 39347955 DOI: 10.1142/S0192415X24500708
    Diabetic kidney disease (DKD) has become the primary cause of end-stage renal disease (ESRD), causing an urgent need for preventive strategies for DKD. Astragaloside I (ASI), a bioactive saponin extracted from Astragalus membranaceus (Fisch.) Bunge has been demonstrated to possess a variety of biological activities. This study investigates the therapeutic potential of ASI in DKD and the underlying molecular mechanism using db/db mice in vivo and high glucose (HG)-induced SV40-MES-13 cells in vitro. The results indicated that ASI significantly ameliorated renal dysfunction and mitigated the pathological alterations in the renal tissues of db/db mice. Moreover, ASI was found to reduce the levels of renal fibrosis makers and suppress the activation of TGF-β1/Smad2/3 pathway in both db/db mice and HG-induced SV40-MES-13 cells. Furthermore, ASI downregulated HDAC3 expression, upregulated Klotho expression, and enhanced Klotho release. ASI is directly bound to HDAC3, and the beneficial effects of ASI on Klotho/TGF-β1/Smad2/3-mediciated renal fibrosis in DKD were reversed by the HDAC3 agonist ITSA-1. In conclusion, ASI attenuates renal fibrosis in DKD, and may act through concurrently inhibiting HDAC3 and TGF-β1, thereby regulating HDAC3-mediciated Klotho/TGF-β1/Smad2/3 pathway.
    MeSH terms: Animals; Cells, Cultured; Disease Models, Animal; Fibrosis; Kidney/drug effects; Kidney/metabolism; Kidney/pathology; Male; Phytotherapy; Mice, Inbred C57BL; Signal Transduction/drug effects; Astragalus Plant/chemistry; Astragalus membranaceus; Mice; Smad2 Protein/metabolism; Smad3 Protein/metabolism
  11. Green CG, Ong MLY, Rowland SN, Bongiovanni T, James LJ, Clifford T, et al.
    Food Funct, 2024 Nov 25;15(23):11525-11536.
    PMID: 39498577 DOI: 10.1039/d4fo04028g
    Acetate, propionate, and butyrate are naturally-occurring short-chain fatty acids (SCFAs) derived from bacterial metabolism of dietary fibre and have been associated with numerous positive health outcomes. All three acids have been shown to offer unique physiological and metabolic effects and, therefore, could be targeted for co-ingestion as part of a nutritional/medicinal plan. However, a better understanding of the outcomes of supplementing in combination on circulating concentration profiles is necessary to confirm uptake efficacy. This study sought to investigate the acute circulating concentration profiles of acetate, propionate, and butyrate following oral supplementation. Three experimental trials were conducted including investigations to understand the impact of capsule coating on circulating concentration profiles, the effect of supplementation dose on uptake kinetics, and the outcome of a short, repeated, supplementation routine on circulating levels. Serum samples were analysed for SCFA content using a quantitative GC-MS assay. It was observed that an acid-resistant coated capsule caused a delayed and blunted blood concentration response, with the non-acid resistant trial displaying earlier and more intense peak serum concentrations. For dose comparison investigations, all SCFAs peaked within 60 min and returned to baseline concentrations by 120 min post-supplementation. A graded dose relationship was present for propionate and butyrate when considering the total circulating exposure across a 240 min monitoring period. In addition, a one-week, twice-daily, repeated supplementation protocol resulted in no changes in basal serum SCFA concentrations. Overall, these data indicate that acetate, propionate, and butyrate display relatively similar circulating concentration profiles following oral co-ingestion, adding knowledge to help inform supplementation strategies for future outcomes where acute elevation of circulating SCFAs is desired.
    MeSH terms: Administration, Oral; Adult; Butyrates/blood; Butyrates/metabolism; Female; Humans; Male; Middle Aged; Propionates/blood; Dietary Supplements*; Young Adult
  12. Roslan MZ, Amran MS, Sommer W
    PMID: 39582428 DOI: 10.1515/ijamh-2024-0150
    OBJECTIVES: Problematic gaming behavior has been an issue in many countries, raising the need for assessment tools. The Game Addiction Scale for Adolescents (GASA) by Lemmens et al. is widely used for assessing game addiction and has been adopted for use in various countries. The GASA consists of 21 items covering several criteria of game addiction: salience, tolerance, mood modification, relapse, withdrawal, conflict, and problems. The present study aimed to investigate the reliability and validity of the GASA when applied to Malaysian adolescents.

    METHODS: The study was conducted in two phases (reliability assessment for phase 1 and validity assessment for phase 2). The Malay version of the Game Addiction Scale was created using a forward-translation procedure with the help of panelists consisting of researchers and educators from the fields of Psychology, Medicine, and Education to translate from English to Malay. The participants of the study were presented with both versions (Malay and English) during the data collection process. The study checked content validity with the help of 33 panelists and reliability based on the scores of 116 participants who spent at least 1 h and up to 6 h per week playing games.

    RESULTS: The reliability was measured using Cronbach's alpha and provided high reliability ranging from 0.671 to 0.903 for all criteria. All criteria scored higher than 0.8 except for relapse (α=0.788) and problems (α=0.671) criteria, indicating that the instrument provides high reliability. The findings from the study show acceptable content validity with high I-CVI values ranging from 0.73 to 0.94 and an S-CVI/Ave value of 0.80. Internal consistency was excellent (α=0.949) and the Content Validity Index (I-CVI) was high for most items.

    CONCLUSIONS: The results suggest that GASA is suitable for application among adolescents in Malaysia.

  13. Wang MK, Devereaux PJ, Marcucci M, Lomivorotov V, Sessler DI, Chan MTV, et al.
    CJC Open, 2024 Nov;6(11):1363-1371.
    PMID: 39582707 DOI: 10.1016/j.cjco.2024.08.003
    BACKGROUND: Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time.

    METHODS: We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021. POAF was defined as new, clinically important atrial fibrillation occurring within 30 days after surgery. We assessed the use of rhythm-control and anticoagulation treatment in response to POAF, at hospital discharge and at 30 days after surgery. We assessed for temporal trends using multivariable logistic regression.

    RESULTS: Of the 27,896 patients included, 545 (1.9%) developed clinically important POAF. Patients received rhythm-control treatment in 48.6% of cases. The level of use of rhythm-control treatment increased over the course of the trials (POISE-1 vs POISE-2 vs POISE-3; 40.9% vs 49.5% vs 59.1%). A later randomization date was associated independently with use of rhythm-control treatment (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.09). Anticoagulation treatment was prescribed in 21% of POAF cases. The level of anticoagulation treatement use was higher in POISE-3, compared to that in the 2 previous trials (POISE-1 vs POISE-2 vs POISE-3-16.4% vs 16.5% vs 33.6%). A later randomization date was associated independently with use of anticoagulation treatment (odds ratio, 1.06 per year; 95% confidence interval, 1.02-1.11).

    CONCLUSIONS: Despite the absence of randomized controlled trials, the level of use of rhythm-control and anticoagulation treatment for POAF is rising. High-quality trials are needed urgently to determine whether these interventions are safe and effective in this population.

  14. Hasrizal Fuad AB, Halmi NZ, Yazid HM, Arifuddin MN, Mukri I, Azidi SNZ, et al.
    Biodivers Data J, 2024;12:e125875.
    PMID: 39582762 DOI: 10.3897/BDJ.12.e125875
    Merapoh, Pahang, is an area rich with limestone karst located within the Lipis National Geopark and home to the Sungai Relau gate of Taman Negara Pahang, a totally protected rainforest in Malaysia. Much of the research conducted here is mainly inside the National Park, with few published faunal records for the Merapoh caves. This study compiled the data on the bat species diversity of eight Merapoh caves (March 2020 to March 2022) using mist nets and harp traps. Our results indicate that Chiroptera diversity at Merapoh caves is rich, with a total of 32 species recorded from 865 individuals and four new locality records for the State of Pahang, namely Rousettusleschenaultii, Lyrodermalyra, Rhinolophuscoelophyllus and Hipposiderospomona. Gua Gunting has the highest diversity of bats recorded in this study (19 species). Significant Merapoh caves with bat colony roosts in Merapoh include Gua Jinjang Pelamin (Eonycterisspelaea & Rousettusleschenaultii), Gua Tahi Bintang (Hipposideroslarvatus) and Gua Pasir Besar (Miniopterusmedius). Rhinolophusconvexus, previously recorded only in upper montane rainforests, was also recorded in Merapoh caves indicating that this species can also be found in lower elevations than previously thought. Based on the findings of the current study and additional records from two previous studies, the Merapoh bat species diversity checklist totalled up to 38 species. On the whole, the rich bat diversity in Merapoh is reflective of its immense limestone karst landscape, which highlights the reason Lipis National Geopark has been recently gazetted. Future bat research should continue here and in other karsts within Lipis Geopark to sustainably conserve biological diversity, manage geological structures and raise awareness amongst the locals to appreciate their national heritage.
  15. Anis Amiera MA, Tuan Kub TN, Harun A, Mohamud R, Razian NRA, Muhammad Ismadi YK, et al.
    PeerJ, 2024;12:e18513.
    PMID: 39583105 DOI: 10.7717/peerj.18513
    OBJECTIVE: To critically analyse literature on the anticancer properties of andrographolide in in vitro studies on gastric cancer cells.

    METHOD: This study systematically reviewed articles from 2013 to 2024 across five prominent databases; PubMed, Google Scholar, Web of Science, Scopus, and Science Direct, EMBASE, Cochrane library and DOAJ. The study eligibility criteria include original studies assessing using gastric cancer cell lines and articles utilizing extracted andrographolide from Andrographis paniculata or standard andrographolide source treatment. The following exclusion criteria were articles written in a different language, review articles, book chapters, conference articles, scientific reports. Duplicated articles were removed using Mendeley software.

    RESULT: Out of 93 articles, six were relevant, primarily focusing on in vitro analyses with gastric adenocarcinoma cell lines.

    CONCLUSION: These studies indicate that andrographolide can hinder the cell cycle, suppress cell proliferation, alleviate oxidative stress, and induce apoptosis by prompting gastric cancer cells to undergo self-destruction, which is a crucial mechanism for controlling and eliminating cancerous growths.

    MeSH terms: Antineoplastic Agents/pharmacology; Antineoplastic Agents/therapeutic use; Antineoplastic Agents, Phytogenic/pharmacology; Antineoplastic Agents, Phytogenic/therapeutic use; Cell Cycle/drug effects; Humans; Oxidative Stress/drug effects; Andrographis/chemistry; Cell Line, Tumor
  16. Badaruddin I', Norbani A, Chin JY, Md Said ES, Selvarajoo U, Mohammad Khaidir NT, et al.
    Cureus, 2024 Oct;16(10):e72155.
    PMID: 39583387 DOI: 10.7759/cureus.72155
    Introduction Gestational diabetes mellitus (GDM) poses a significant health concern due to the numerous risks it presents to both the mother and fetus. While serum ferritin typically declines in cases of iron deficiency anemia, which is common during pregnancy, it may increase in the presence of inflammation. This study aims to evaluate the significance of serum ferritin in the context of GDM, considering its multifaceted role in these interconnected conditions. Methodology This cross-sectional study included pregnant women attending an obstetrics clinic for an oral glucose tolerance test at Hospital Canselor Tuanku Muhriz in Kuala Lumpur, Malaysia. With consent, demographic data, risk factors for GDM, and blood samples were collected. Blood samples were analyzed for serum ferritin, fasting blood glucose, two-hour post-glucose levels, and full blood count. The assessment of risk factors for GDM and the diagnosis of GDM adhered to Malaysian guidelines. The Mann-Whitney U test was employed to compare variables between the GDM and non-gestational diabetes mellitus (non-GDM) groups. Additionally, univariate and multivariate regression analyses were conducted to investigate the role of serum ferritin in GDM. All analyses were performed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05. Results Among 172 pregnant women with an average gestational age of 23.6 weeks, the incidence of GDM was higher in those with risk factors (84.8%) compared to non-GDM participants (75.5%). Women with GDM had a slightly higher mean serum ferritin level (50.24 ± 29.00 ng/mL) than those without GDM (45.00 ± 58.69 ng/mL). However, ferritin levels did not significantly differ between the GDM and non-GDM groups (p = 0.669) or between those with and without risk factors (p = 0.374). While a higher BMI (OR: 0.832, p = 0.017) and ferritin (OR: 1.022, p = 0.031) levels independently predicted GDM, the predictive value of ferritin was borderline significant when combined with glucose tests (area under the curve = 0.689, p = 0.051). Conclusions Higher maternal serum ferritin levels in the mid-trimester are associated with increased BMI and GDM. However, maternal serum ferritin is most effective at predicting the incidence of GDM when used alongside standard glucose measurements, especially in women with elevated BMI.
  17. Govindasamy M, Ganthel Annamalai K, Binti Md Sham LA
    Cureus, 2024 Oct;16(10):e72332.
    PMID: 39583441 DOI: 10.7759/cureus.72332
    Background and objectives Hemophilic arthropathy is a known complication of patients with hemophilia, with the knee as the commonest joint affected. Patients with this condition have severe pain and restricted joint mobility, affecting their activities of daily living. Total knee replacement can increase these patients' quality of life. Nevertheless, this surgery has a high risk of complications due to the nature of the underlying hemophilia. In this study, we present the short-term outcome of a case series of six patients with hemophilic arthropathy who underwent total knee replacement at a hospital with hematology support performed by an experienced arthroplasty surgeon. Patients and method This study reviewed and included eight consecutive total knee replacements in six patients with hemophilic arthropathy performed by a single board-certified arthroplasty surgeon from 2019 to 2023. The demographic profile of the patients, pre- and postoperative range of movement, and short-term outcome scores were summarized. Results The mean preoperative flexion contracture was 10.6° (range: 5°-30°), and it was 0.7° (range: 0°-5°) postoperatively. The mean preoperative flexion of the knee was 78.1° (range: 45°-110°) and 98.8° postoperatively. At six-month follow-up, the average Knee Society Score expectation, satisfaction, and functional scores had improved from 8.3 to 13.8 points, 20 to 38.5 points, and 42.8 to 80.5 points, respectively. Conclusion This study suggests that short-term results of total knee replacement in patients with hemophilic arthropathy are favorable, with increased range of movement and quality of life. We also conclude that surgery should be performed by an experienced surgeon with the support of a dedicated hematology unit.
  18. Yung Chwen WL, Abdul Wahab AH, Ahmad Affandi K
    Cureus, 2024 Oct;16(10):e72381.
    PMID: 39583538 DOI: 10.7759/cureus.72381
    Papillary thyroid carcinoma often emerges within the middle-aged group as a painless, irregular thyroid mass, and it can be accompanied by other symptoms such as hoarseness and dysphagia. Cervical node metastasis typically involves the ipsilateral jugular chain and remains confined to cervical node levels III and IV in most of the patients. Here, we present a case highlighting the uncommon presentation of papillary thyroid carcinoma. A 63-year-old Malay man with no known medical issues initially exhibited a painless swelling on the right neck level V region. The swelling progressively grew in size and later extended toward the anterior and contralateral sides of the neck for a duration of a year. He reported a weight loss of 10 kg past a year and experienced consistent fatigue. Physical examination showed multiple firm swellings with regular borders over levels I to V bilaterally. The swellings did not move upon swallowing. Due to the absence of initial thyroid swelling and the presence of multiple cervical lymphadenopathies in his medical history, lymphoma was suspected. A referral to ENT was made for an excision biopsy, but the procedure was abandoned to prevent potential injury to important underlying structures such as blood vessels and nerves. An ultrasound-guided biopsy was subsequently performed over multiple neck regions. It resulted in papillary thyroid carcinoma instead of lymphoma. Despite a suggestive history of lymphoma, papillary thyroid carcinoma should be considered a potential differential for a multilobulated neck mass. Excision biopsy has the potential to upstage the tumor and worsen the patient's prognosis. Fine-needle aspiration for cytology should be prioritized when investigating any neck swelling.
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