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Fulltext An Update on Zika Virus in Asia

Lim SK, Lim JK, Yoon IK

Infect Chemother, 2017 Jun;49(2):91-100.
PMID: 28681575 DOI: 10.3947/ic.2017.49.2.91

Zika virus (ZIKV) was first isolated in Asia from mosquitoes from Malaysia in 1966. However, the incidence of Zika and Zika-related neurological complications in Asia is not well known. The few studies of Zika in Asia have been inconsistent in pointing to likely transmission levels, with some studies suggesting substantial transmission and others not. Interpretation of existing epidemiological and public health data from Asia is constrained by the non-specific symptomatology of Zika, the high proportion of subclinical ZIKV infections, relatively low viremia, and the lack of accurate serological assays. Here, we update the status of Zika cases from countries in Asia, and highlight some key knowledge gaps. In particular, accurate determinations of the incidence of Zika-related congenital Zika syndrome should be a priority for Zika research in Asia. Additional information will be critical to make informed strategies for the prevention and control of this global public health threat.
Characterization of Matured Vermicompost Derived from Valorization of Palm Oil Mill Byproduct

Lim SL, Wu TY

J Agric Food Chem, 2016 Mar 2;64(8):1761-9.
PMID: 26844586 DOI: 10.1021/acs.jafc.6b00531

The valorization process involves transforming low-value materials such as wastes into high-value-added products. The current study aims to determine the potential of using a valorization process such as vermicomposting technology to convert palm oil mill byproduct, namely, decanter cake (DC), into organic fertilizer or vermicompost. The maturity of the vermicompost was characterized through various chemical and instrumental characterization to ensure the end product was safe and beneficial for agricultural application. The vermicomposting of DC showed significantly higher nutrient recovery and decreases in C:N ratio in comparison with the controls, particularly in the treatment with 2 parts DC and 1 part rice straw (w/w) (2DC:1RS). 2DC:1RS vermicompost had a final C:N ratio of 9.03 ± 0.12 and reasonably high levels of calcium (1.13 ± 0.05 g/kg), potassium (25.47 ± 0.32 g/kg), magnesium (4.87 ± 0.19 g/kg), sodium (7.40 ± 0.03 g/kg), and phosphorus (3.62 ± 0.27 g/kg). In addition, instrumental characterization also revealed a higher degree of maturity in the vermicompost. Ratios of 2921:1633 and DTG2:DTG3 also showed significant linear correlations with the C:N ratio, implying that those ratios could be used to characterize the progression of vermicompost maturity during the valorization process of DC.
Fulltext Review of an 11-year Experience in Retrosigmoid Approach for Treatment of Acoustic Neuromas

Lim SL, Wong SH

Med J Malaysia, 2013 Jun;68(3):253-8.
PMID: 23749017 MyJurnal

This study reviews surgery on acoustic neuromas by the second author using retrosigmoid approach from January 2000 to June 2010 in the state of Sarawak. There was a total of 32 patients in this study. The commonest presenting symptom was hearing loss (81.3%), followed by headache and tinnitus (each 37.5%), ataxia (34.4%) and facial numbness (21.9%). Twenty-seven patients (84.4%) had large tumor (≥ 3cm) while 5 patients (15.6%) had medium size tumor (1.5-2.9cm). The mean tumor size was 3.6 cm. Facial nerve outcome was good to moderate in 93.7% (House and Brackmann Grade I-IV). The most common complications were CSF leak with 3 patients(9.4%) and facial numbness with 2 patients(6.3%). All either resolved with treatment or improved. There was no mortality. Excision of acoustic neuromas using retrosigmoid approach could achieve acceptable facial nerve outcome with a low incidence of morbidity without mortality.
Fulltext Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward

Sim SK, Lim SL, Lee HK, Liew D, Wong A

Med J Malaysia, 2011 Jun;66(2):138-41.
PMID: 22106695 MyJurnal

Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.
Fulltext Preserved glucagon-like peptide-1 responses to oral glucose, but reduced incretin effect, insulin secretion and sensitivity in young Asians with type 2 diabetes mellitus

Yeow TP, Pacini G, Tura A, Hor CP, Lim SL, Tan FH, et al.

BMJ Open Diabetes Res Care, 2017;5(1):e000352.
PMID: 28321312 DOI: 10.1136/bmjdrc-2016-000352

OBJECTIVE: Youth onset type 2 diabetes mellitus (YT2DM) is a globally rising phenomenon with substantial Asians representation. The understanding of its pathophysiology is derived largely from studies in the obese African-American and Caucasian populations, while studies on incretin effect are scarce. We examined the insulin resistance, β-cell function (BC), glucagon-like peptide (GLP)-1 hormone and incretin effect in Asian YT2DM.

RESEARCH DESIGN AND METHODS: This case-control study recruited 25 Asian YT2DM and 15 healthy controls, matched for gender, ethnicity and body mass index. Serum glucose, insulin, C peptide and GLP-1 were sampled during 2-hour oral glucose tolerance tests (OGTTs) and 1-hour intravenous glucose tolerance tests (IVGTTs). Insulin sensitivity was derived from the Quantitative Insulin Sensitivity Check Index (QUICKI), Oral Glucose Insulin Sensitivity Index (OGIS) in OGTT and surrogate index of SI from the minimal model (calculated SI, CSI). Acute insulin response (AIR) was obtained from IVGTT. Total BC was computed as incremental area under the curve of insulin/incremental area under the curve of glucose, during OGTT (BCOG) and IVGTT (BCIV), respectively. Disposition index (DI) was calculated using the product of insulin sensitivity and insulin secretion. GLP-1 response to oral glucose was calculated as incremental area under the curve of GLP-1 (ΔAUCGLP-1). Per cent incretin effect was estimated as 100×(BCOG-BCIV)/BCOG).

RESULTS: The YT2DM had marked impairment in BC (>80% reduction in AIR and BCOG, p<0.001) and lower QUICKI (p<0.001), OGIS (p<0.001) and CSI (p=0.015) compared with controls. There was no difference in GLP-1 at all time points and ΔAUCGLP-1 but the per cent incretin effect was reduced in the YT2DM compared with controls (12.1±8.93 vs 70.0±4.03, p<0.001).

CONCLUSIONS: Asian YT2DM showed similar GLP-1 response to oral glucose as controls but reduced incretin effect, BC and insulin sensitivity. The lack of compensatory mechanisms, as shown by the DI may be partly ascribed to the impaired incretin effect, similar to that of adult T2DM.

TRIAL REGISTRATION NUMBER: NMRR-12-1042-13254.
Cobalt nanoparticle supported on layered double hydroxide: Effect of nanoparticle size on catalytic hydrogen production by NaBH4 hydrolysis

Mahpudz A, Lim SL, Inokawa H, Kusakabe K, Tomoshige R

Environ Pollut, 2021 Aug 24;290:117990.
PMID: 34523515 DOI: 10.1016/j.envpol.2021.117990

Catalytic hydrolysis of sodium borohydride (NaBH4) is a promising method to provide clean hydrogen (H2) energy for portable devices. Therefore, designing a non-noble metal catalyst that performs well in this hydrolysis is essential. Cobalt-nanoparticles (Co-NPs) supported on magnesium-aluminium layered double hydroxide (LDH) with various mean diameter were synthesized by changing concentration of cobalt-citrate anion (Co-citrate) precursor used for ion exchange with the LDH host. Then the Co-citrate intercalated LDHs were reduced with NaBH4 to form Co-NPs. Evidence of successful intercalation was shown by X-ray diffraction (XRD) and Fourier-Transform Infrared spectroscopy (FT-IR). Transmission Electron Microscope (TEM) and Scanning TEM (STEM) observations revealed that Co-NPs were in metallic state and their mean diameter increased with the concentration of Co-citrate solution. Nitrogen physisorption isotherms showed that the surface structure of LDHs transformed from non-porous to mesoporous after chemical reduction, which indicated that the Co-NPs were formed in the interlayer of LDHs. Catalytic hydrolysis of NaBH4 at 25 °C clarified that the catalyst synthesized from 6 mM Co-citrate solution showed the highest H2 generation rate of 4520 ± 251 mL min-1·gCo-1, indicating the catalyst had the optimum size of Co-NP. This activity could be considered relatively higher compared to unsupported cobalt and many other supported cobalt-base catalysts previously reported. It was also clearly shown that size of Co-NPs supported on LDH could be a significant parameter as it allowed better accessibility of reactants to the active catalyst surface to obtain maximum activity. For this optimum catalyst, the activation energy was evaluated to be 56.9 kJ mol-1. Although the catalyst was able to achieve almost the same conversion when the catalyst was repeatedly tested five times under the same condition, the catalytic activity decreased gradually. Overall, it could be revealed that Co-NPs supported on LDHs have a huge potential to be used for H2 energy production.
Fulltext Diversity and killer activity of yeasts in Malaysian fermented food samples

Lim SL, Tay ST

Trop Biomed, 2011 Aug;28(2):438-43.
PMID: 22041766

The biodiversity and the killer activity of yeasts isolated from various types of fermented food in Malaysia were investigated in this study. Of 252 yeasts isolated from 48 fermented food samples in this study, 19 yeast species were identified based on sequence analysis of the ITS1-5.8S-ITS2 partial fragments of the yeasts. A total of 29 (11.5%) of the yeast isolates demonstrated killer activity to at least one Candida species tested in this study; including 22 isolates of Trichosporon asahii, 4 isolates of Pichia anomala, and one isolate each of Pichia norvegensis, Pichia fermentans and Issatchenkia orientalis, respectively. The presence of killer yeasts reflects antagonism that occurs during microbial interaction in the fermented food, whereby certain yeasts produce killer toxins and possibly other toxic substances in competition for limited nutrients and space. The anti-Candida activity demonstrated by killer yeasts in this study should be further explored for development of alternative therapy against candidiasis.
Evaluation of illness perceptions and their associations with glycaemic control, medication adherence and chronic kidney disease in type 2 diabetes mellitus patients in Malaysia

Balasubramaniam S, Lim SL, Goh LH, Subramaniam S, Tangiisuran B

Diabetes Metab Syndr, 2019 07 09;13(4):2585-2591.
PMID: 31405680 DOI: 10.1016/j.dsx.2019.07.011

BACKGROUND: Illness perceptions (IP) involve coping strategies and behavioural responses that can influence glycaemic control. Despite the importance of good glycaemic control, the majority of patients in Asia are not achieving glycaemic targets. An evaluation of IP in association with glycaemic control, medication adherence and chronic kidney disease (CKD) in Type 2 diabetes mellitus patients (T2DM) was carried out in an outpatient setting in Malaysia METHOD: A cross-sectional study was conducted using the Revised Illness Perception Questionnaire in a purposive sample of 384 T2DM patients.
RESULTS: There were 55.7% females, median age was 58.2 years and median duration of diabetes was 13 years. The majority (79.4%) of patients had poor diabetes control (HbA1c ≥ 7.0%) and 39.6% of patients had low medication adherence. Patients with good glycaemic control had a higher Timeline Acute/Chronic and Emotional Representations score, hence they held the correct belief that diabetes is chronic and experienced negative emotions. Highly adherent patients had a higher Illness Coherence (χ2 = 21.385, p 
Fulltext Growth inhibition of Candida species by Wickerhamomyces anomalus mycocin and a lactone compound of Aureobasidium pullulans

Tay ST, Lim SL, Tan HW

BMC Complement Altern Med, 2014;14:439.
PMID: 25380692 DOI: 10.1186/1472-6882-14-439

The increasing resistance of Candida yeasts towards antifungal compounds and the limited choice of therapeutic drugs have spurred great interest amongst the scientific community to search for alternative anti-Candida compounds. Mycocins and fungal metabolites have been reported to have the potential for treatment of fungal infections. In this study, the growth inhibition of Candida species by a mycocin produced by Wickerhamomyces anomalus and a lactone compound from Aureobasidium pullulans were investigated.
Fulltext Risk factors associated with low anterior resection syndrome: a cross-sectional study

Lim SL, Wan Zain WZ, Zahari Z, Zakaria AD, Hashim MNM, Wong MP, et al.

Ann Coloproctol, 2023 Oct;39(5):427-434.
PMID: 35655395 DOI: 10.3393/ac.2022.00227.0032

PURPOSE: Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS.
METHODS: This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery.
RESULTS: Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06-9.13).
CONCLUSION: Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery.
Revisiting Wallace's haunt: coalescent simulations and comparative niche modeling reveal historical mechanisms that promoted avian population divergence in the Malay Archipelago

Lim HC, Rahman MA, Lim SL, Moyle RG, Sheldon FH

Evolution, 2011 Feb;65(2):321-34.
PMID: 20796023 DOI: 10.1111/j.1558-5646.2010.01105.x

Sundaland, a biogeographic region of Southeast Asia, is a major biodiversity hotspot. However, little is known about the relative importance of Pleistocene habitat barriers and rivers in structuring populations and promoting diversification here. We sampled 16 lowland rainforest bird species primarily from peninsular Malaysia and Borneo to test the long-standing hypothesis that animals on different Sundaic landmasses intermixed extensively when lower sea-levels during the Last Glacial Maximum (LGM) exposed land-bridges. This hypothesis was rejected in all but five species through coalescent simulations. Furthermore, we detected a range of phylogeographic patterns; Bornean populations are often genetically distinct from each other, despite their current habitat connectivity. Environmental niche modeling showed that the presence of unsuitable habitats between western and eastern Sundaland during the LGM coincided with deeper interpopulation genetic divergences. The location of this habitat barrier had been hypothesized previously based on other evidence. Paleo-riverine barriers are unlikely to have produced such a pattern, but we cannot rule out that they acted with habitat changes to impede population exchanges across the Sunda shelf. The distinctiveness of northeastern Borneo populations may be underlied by a combination of factors such as rivers, LGM expansion of montane forests and other aspects of regional physiography.
The use of vermicompost in organic farming: overview, effects on soil and economics

Lim SL, Wu TY, Lim PN, Shak KP

J Sci Food Agric, 2015 Apr;95(6):1143-56.
PMID: 25130895 DOI: 10.1002/jsfa.6849

Vermicomposting is a process in which earthworms are used to convert organic materials into humus-like material known as vermicompost. A number of researchers throughout the world have found that the nutrient profile in vermicompost is generally higher than traditional compost. In fact, vermicompost can enhance soil fertility physically, chemically and biologically. Physically, vermicompost-treated soil has better aeration, porosity, bulk density and water retention. Chemical properties such as pH, electrical conductivity and organic matter content are also improved for better crop yield. Nevertheless, enhanced plant growth could not be satisfactorily explained by improvements in the nutrient content of the soil, which means that other plant growth-influencing materials are available in vermicomposts. Although vermicomposts have been shown to improve plant growth significantly, the application of vermicomposts at high concentrations could impede growth due to the high concentrations of soluble salts available in vermicomposts. Therefore, vermicomposts should be applied at moderate concentrations in order to obtain maximum plant yield. This review paper discusses in detail the effects of vermicompost on soil fertility physically, chemically and biologically. Future prospects and economy on the use of organic fertilizers in the agricultural sector are also examined.
Fulltext A Questionnaire-based Survey on Depression and Anxiety among Rheumatology Patients during the COVID-19 Pandemic: Patient's Perspective

Lim SL, Tay VY, Bhullar A, Baharuddin H, Ch'ng SS, Yusoof HM, et al.

Oman Med J, 2021 Sep;36(5):e305.
PMID: 34733551 DOI: 10.5001/omj.2022.34

Objectives: The Coronavirus Disease 2019 (COVID-19) outbreak is a global pandemic and has caught the attention of the rheumatology fraternity, where patients are thought to be at higher risk of infection. We aimed to study the incidence of COVID-19 infection and depression and anxiety symptoms among patients with rheumatic disease (RD) in Hospital Selayang, Malaysia, during the COVID-19 pandemic.
Methods: A cross-sectional study was conducted via phone interview using a structured questionnaire in patients with RD aged > 18 years old scheduled for clinic appointments from 4 to 28 May 2020, which coincided with the second wave of COVID-19 cases in Malaysia. The questionnaire included demographics, COVID-19 screening questions, depression and anxiety symptoms screening using questions derived from the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2).
Results: Among the 361 patients enrolled, the majority were females (83.1%), and over half (54.3%) were ethnic Malays, 41.6% had rheumatoid arthritis, 34.6% had systemic lupus erythematosus, 12.2% had spondyloarthropathy, and only one (0.3%) patient had COVID-19 infection. The mean age of patients was 48.2 years (range: 16-80 years). The frequency of patients with depression and anxiety symptoms was 8.6% and 6.9%, respectively. Married patients reported feeling more anxious (p =0.013), while patients with tertiary education levels reported feeling more depressed (p =0.012).
Conclusions: The incidence of COVID-19 infection is low, probably due to the low rate of testing. Depression and anxiety symptoms reported by patients in our cohort were modest. Our findings suggest that the COVID-19 pandemic has a greater impact on married patients with RD and those with a higher education level.
Use of Chlorella vulgaris for bioremediation of textile wastewater

Lim SL, Chu WL, Phang SM

Bioresour Technol, 2010 Oct;101(19):7314-22.
PMID: 20547057 DOI: 10.1016/j.biortech.2010.04.092

The potential application of Chlorella vulgaris UMACC 001 for bioremediation of textile wastewater (TW) was investigated using four batches of cultures in high rate algae ponds (HRAP) containing textile dye (Supranol Red 3BW) or TW. The biomass attained ranged from 0.17 to 2.26 mg chlorophyll a/L while colour removal ranged from 41.8% to 50.0%. There was also reduction of NH(4)-N (44.4-45.1%), PO(4)-P (33.1-33.3%) and COD (38.3-62.3%) in the TW. Supplementation of the TW with nutrients of Bold's Basal Medium (BBM) increased biomass production but did not improve colour removal or reduction of pollutants. The mechanism of colour removal by C. vulgaris is biosorption, in accordance with both the Langmuir and Freundlich models. The HRAP using C. vulgaris offers a good system for the polishing of TW before final discharge.
Fulltext Impact of Vitamin D Replacement on Markers of Glucose Metabolism and Cardio-Metabolic Risk in Women with Former Gestational Diabetes--A Double-Blind, Randomized Controlled Trial

Yeow TP, Lim SL, Hor CP, Khir AS, Wan Mohamud WN, Pacini G

PLoS One, 2015;10(6):e0129017.
PMID: 26057782 DOI: 10.1371/journal.pone.0129017

Gestational Diabetes Mellitus (GDM) and vitamin D deficiency are related to insulin resistance and impaired beta cell function, with heightened risk for future development of diabetes. We evaluated the impact of vitamin D supplementation on markers of glucose metabolism and cardio metabolic risk in Asian women with former GDM and hypovitaminosis D. In this double blind, randomized controlled trial, 26 participants were randomized to receive either daily 4000 IU vitamin D3 or placebo capsules. 75 g Oral Glucose Tolerance Test (OGTT) and biochemistry profiles were performed at baseline and 6 month visits. Mathematical models, using serial glucose, insulin and C peptide measurements from OGTT, were employed to calculate insulin sensitivity and beta cell function. Thirty three (76%) women with former GDM screened had vitamin D level of <50 nmol/L at baseline. Supplementation, when compared with placebo, resulted in increased vitamin D level (+51.1 nmol/L vs 0.2 nmol/L, p<0.001) and increased fasting insulin (+20% vs 18%, p = 0.034). The vitamin D group also demonstrated a 30% improvement in disposition index and an absolute 0.2% (2 mmol/mol) reduction in HbA1c. There was no clear change in insulin sensitivity or markers of cardio metabolic risk. This study highlighted high prevalence of vitamin D deficiency among Asian women with former GDM. Six months supplementation with 4000 IU of vitamin D3 safely restored the vitamin D level, improved basal pancreatic beta-cell function and ameliorated the metabolic state. There was no effect on markers of cardio metabolic risk. Further mechanistic studies exploring the role of vitamin D supplementation on glucose homeostasis among different ethnicities may be needed to better inform future recommendations for these women with former GDM at high risk of both hypovitaminosis D and future diabetes.
Fulltext Glycaemic control and cost analysis when changing from gliclazide co-administered with metformin to pre-combined glibenclamide-metformin tablets in type 2 diabetes mellitus

Lim PC, Lim SL, Oiyammaal C

Med J Malaysia, 2012 Feb;67(1):21-4.
PMID: 22582544

Type-2 diabetes mellitus (T2DM) patients who were on gliclazide co-administered with metformin were changed to pre-combined glibenclamide-metformin tablets in the Endocrine Clinic, Penang Hospital. We conducted a retrospective study to evaluate the differences in glycaemic control and treatment cost following the change. Eighty patients (60% females) with a mean age of 55 years old were studied. Mean glycosylated haemoglobin (HbAlc) reduction was -0.92% (p<0.01) and -0.83% (p<0.01) after three and six months respectively. Patients with baseline HbA1c > or =8% had greater reduction in mean HbA1c (-1.36%) after six months. The treatment cost per month was reduced by 45% at 3 months (p<0.01)) and 44% at 6 months (p<0.01). The change to pre-combined glibenclamide-metformin tablets resulted in significant improvement in glycaemia and reduction in treatment cost.
Fulltext Knowledge, attitude and practices towards osteoporosis prevention among adults in Kuala Lumpur, Malaysia

Lim SL, Ali A, Mohd Yusof H

Malays J Nutr, 2017;23(2):279-290.
MyJurnal

Introduction: Osteoporosis is a major health problem worldwide. In Asia, few studies have measured knowledge, attitude and practices (KAP) of osteoporosis. This study aimed to determine the KAP of osteoporosis, including the main factors influencing attitude towards osteoporosis, and the relationship between osteoporosis knowledge, attitude, and practices among adults in Kuala Lumpur, Malaysia.
Methods: A cross-sectional study via a self-administrated KAP questionnaire was carried out among 232 respondents aged 21 to 50 years in Kuala Lumpur. Random sampling was applied to select five districts in Kuala Lumpur, while convenient sampling was used for recruitment of apparently healthy subjects from community and institutional settings. The data were analysed using Mann-Whitney, Kruskal-Wallis, Chi-Square, Spearman Correlation and multiple logistic regression tests.
Results: The findings indicate a moderate level of knowledge and attitude towards osteoporosis prevention with median scores of 51.6% and 68.6%, respectively. Osteoporosis knowledge varied significantly with gender, educational level and household income (p<0.05). Furthermore, attitude was significantly different in relation to educational level and household income. Based on the multiple logistic regression test, relatives and friends appeared to be the most significant factor influencing attitude (R=0.319, p<0.0001). Poor dietary and lifestyles practices were indicated, and a significant relationship was found between practice of weight-bearing activities and educational level (p<0.05). A significant correlation was found (ρ=0.348, p<0.0001) between knowledge and attitude, while no relationship was noted between knowledge and practice of weight-bearing activities or attitude and practice of weight-bearing activities.
Conclusion: Knowledge played a significant role in affecting attitudes towards osteoporosis. However, understanding of osteoporosis is still at a moderate level. Friends and family were the most influential factor.
Key words: Adults, attitude, knowledge, osteoporosis, practices
Fulltext Radioiodine I-131 for the therapy of graves' disease

Mumtaz M, Lim SL, Khaw CH, Mohd Khir AS

Malays J Med Sci, 2009 Jan;16(1):25-33.
PMID: 22589645

Graves' disease is a common cause of hyperthyroidism. Treatment options for Graves' disease include antithyroid medication, surgery or radioactive iodine (I-31) or RAI. This review will focus on the approach to RAI therapy; discussing dose selection, patient preparation, and consideration before and after administering RAI, examining aspects of pre-treatment with antithyroid medication as well as discussing possible adverse events including hypothyroidism and possible worsening of thyroid-associated opthalmopathy. Follow-up is lifelong with the aim of ensuring the patient remains euthyroid or on replacement therapy if there is evidence of hypothyroidism. While there are controversies in treatment of thyrotoxicosis with RAI, with appropriate patient selection and regular follow-up, radioiodine is a safe and effective modality in achieving high cure rates.
Morinda citrifolia edible leaf extract enhanced immune response against lung cancer

Lim SL, Goh YM, Noordin MM, Rahman HS, Othman HH, Abu Bakar NA, et al.

Food Funct, 2016 Feb;7(2):741-51.
PMID: 26765787 DOI: 10.1039/c5fo01475a

Lung cancer causes 1.4 million deaths annually. In the search for functional foods as complementary therapies against lung cancer, the immuno-stimulatory properties of the vegetable Morinda citrifolia leaves were investigated and compared with the anti-cancer drug erlotinib. Lung tumour-induced BALB/c mice were fed with 150 mg kg(-1) or 300 mg kg(-1) body weight of the leaf extract, or erlotinib (50 mg kg(-1) body-weight) for 21 days. The 300 mg kg(-1) body weight extract significantly (and dose-dependently) suppressed lung tumour growth; the extract worked more effectively than the 50 mg kg(-1) body weight erlotinib treatment. The extract significantly increased blood lymphocyte counts, and spleen tissue B cells, T cells and natural killer cells, and reduced the epidermal growth factor receptor (EGFR) which is a lung adenocarcinoma biomarker. The extract also suppressed the cyclooxygenase 2 (COX2) inflammatory markers, and enhanced the tumour suppressor gene (phosphatase and tensin homolog, PTEN). It inhibited tumour growth cellular gene (transformed mouse 3T3 cell double minute 2 (MDM2), V-raf-leukemia viral oncogene 1 (RAF1), and mechanistic target of rapamycin (MTOR)) mRNA expression in the tumours. The extract is rich in scopoletin and epicatechin, which are the main phenolic compounds. The 300 mg kg(-1)Morinda citrifolia leaf 50% ethanolic extract showed promising potential as a complementary therapeutic dietary supplement which was more effective than the 50 mg kg(-1) erlotinib in suppressing lung adenocarcinoma. Part of the mechanisms involved enhancing immune responses, suppressing proliferation and interfering with various tumour growth signalling pathways.
Metastasized lung cancer suppression by Morinda citrifolia (Noni) leaf compared to Erlotinib via anti-inflammatory, endogenous antioxidant responses and apoptotic gene activation

Lim SL, Mustapha NM, Goh YM, Bakar NA, Mohamed S

Mol Cell Biochem, 2016 May;416(1-2):85-97.
PMID: 27106908 DOI: 10.1007/s11010-016-2698-x

Metastasized lung and liver cancers cause over 2 million deaths annually, and are amongst the top killer cancers worldwide. Morinda citrifolia (Noni) leaves are traditionally consumed as vegetables in the tropics. The macro and micro effects of M. citrifolia (Noni) leaves on metastasized lung cancer development in vitro and in vivo were compared with the FDA-approved anti-cancer drug Erlotinib. The extract inhibited the proliferation and induced apoptosis in A549 cells (IC50 = 23.47 μg/mL) and mouse Lewis (LL2) lung carcinoma cells (IC50 = 5.50 μg/mL) in vitro, arrested cancer cell cycle at G0/G1 phases and significantly increased caspase-3/-8 without changing caspase-9 levels. The extract showed no toxicity on normal MRC5 lung cells. Non-small-cell lung cancer (NSCLC) A549-induced BALB/c mice were fed with 150 and 300 mg/kg M. citrifolia leaf extract and compared with Erlotinib (50 mg/kg body weight) for 21 days. It significantly increased the pro-apoptotic TRP53 genes, downregulated the pro-tumourigenesis genes (BIRC5, JAK2/STAT3/STAT5A) in the mice tumours, significantly increased the anti-inflammatory IL4, IL10 and NR3C1 expression in the metastasized lung and hepatic cancer tissues and enhanced the NFE2L2-dependent antioxidant responses against oxidative injuries. The extract elevated serum neutrophils and reduced the red blood cells, haemoglobin, corpuscular volume and cell haemoglobin concentration in the lung cancer-induced mammal. It suppressed inflammation and oedema, and upregulated the endogenous antioxidant responses and apoptotic genes to suppress the cancer. The 300 mg/kg extract was more effective than the 50 mg/kg Erlotinib for most of the parameters measured.

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