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  1. Khoo PY, Lam C, Tang SF, Perera S, Cheng TC, Md Din N
    Ophthalmic Res, 2024;67(1):635-643.
    PMID: 39427647 DOI: 10.1159/000542081
    INTRODUCTION: This study investigated the intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in open-angle glaucoma (OAG) patients after combined cataract surgery with iStent implantation.

    METHODS: This was a prospective non-randomized comparative study. Eyes with OAG and cataracts that were planned for either combined phacoemulsification and iStent implantation (iStent+CS) or phacoemulsification alone (CS) were recruited. The iStent inject (Model G2-M-IS) or iStent injectW (Model G2-W) trabecular micro-bypass stent (Glaukos Corporation, San Clemente, CA, USA) was implanted in the iStent+CS group. WDT was performed before and 3 months after surgery. WDT-IOP parameters including peak IOP, IOP fluctuation, and area under the curve (AUC) were compared between the two groups.

    RESULTS: There were 20 eyes in the iStent+CS group and 16 eyes in the CS group. Both groups had similar pre-operative baseline IOP (15.6 ± 3.7 mm Hg vs. 15.8 ± 1.8 mm Hg in the iStent+CS and CS group, respectively, p = 0.883). The iStent+CS group experienced greater numerical reduction in peak IOP (2.6 ± 1.9 mm Hg vs. 1.9 ± 2.4 mm Hg; p = 0.355), IOP fluctuation (1.7 ± 2.2 mm Hg vs. 0.8 ± 2.5 mm Hg; p = 0.289), and AUC (54.8 ± 103.6 mm Hg × minute vs. 25.3 ± 79.0 mm Hg × minute; p = 0.355) than the CS group. There was more reduction in the number of anti-glaucoma medications in the iStent+CS group (1.4 ± 1.2) than the CS group (0.3 ± 0.9; p = 0.005).

    CONCLUSION: Both combined phacoemulsification with iStent inject implantation and phacoemulsification alone reduced peak IOP, IOP fluctuation, and AUC, and none of these parameters showed statistically significant difference. Greater reduction in anti-glaucoma medications was seen in the combined group.

  2. Md Ali SRA, Mohd Nor K, Abu Bakar S, Sheikh Ab Hamid S
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):5861-5863.
    PMID: 39559060 DOI: 10.1007/s12070-024-04924-0
    We present a case report of congenital nasal pyriform aperture stenosis, in which the child was managed with a series of less invasive surgical procedures, which were eventually followed by repair via a sublabial approach. This case report aims to highlight that in severe stenosis, earlier open surgical intervention with bone drilling is suggested, as dilatation alone will result in recurrent stenosis. Open surgery with bone drilling not only facilitates faster recovery but also aids in oxygen weaning, shortens hospitalization duration, and reduces the risk of complications.
  3. Salim I, Mohd Saad MS, Ahmad Kailani AAA, Md Daud MK
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):6009-6012.
    PMID: 39559024 DOI: 10.1007/s12070-024-05054-3
    Skull base osteomyelitis (SBO) is a rare and lethal infection of temporal bone, uncommonly caused by purulent otitis media. Although uncommon, a young and immunocompetent person is not exceptional to develop SBO as in our case. We reported a case of SBO in a young, immunocompetent gentleman who presented with right otorrhea associated with fever, trismus, headache, and neck stiffness, which was unresponsive to oral and topical antibiotics. Examination revealed fullness at the right mastoid tip with no evidence of mastoid abscess, trismus, with restrictions of neck movements. Otoscopy of right ear showed mucopus with 10% anterosuperior tympanic membrane perforation without keratin or granulation tissue. Pus for culture and sensitivity grew Klebsiella pneumonia and computed tomography (CT) showed osteomyelitic changes with associated parapharyngeal collection. The patient was started on intravenous antimicrobial therapy and responded well to the treatment.
  4. Abdul Halim N, Md Yassin M, Mohamad Ali ND, Miptah HN
    Am J Case Rep, 2024 Sep 11;25:e944399.
    PMID: 39256984 DOI: 10.12659/AJCR.944399
    BACKGROUND Eagle syndrome is an uncommon medical illness that can manifest as neck pain in primary care. It results from an abnormally unilateral or bilateral long styloid process that may compress and affect adjacent structures, which leads to the symptoms. Classical Eagle syndrome has been commonly reported, but this case highlights the uncommon involvement of autonomic nerve dysfunction. CASE REPORT This case report details a 43-year-old woman with chronic neck pain for 5 years who saw numerous medical professionals and underwent 8 physiotherapy sessions. Marginal improvement of her neck pain and recent development of imbalance and a floating sensation prompted escalation of radiological imaging that eventually led to the diagnosis of Eagle syndrome. She was subsequently subjected to tonsillectomy and styloidectomy to address the sources of her neck pain. CONCLUSIONS Neck pain is a common complaint in primary care, but Eagle syndrome is often overlooked due to its complex symptoms, which mimic other conditions resulting in missed diagnoses and prolonged diagnostic evaluations. To improve patient care and outcomes, primary care physicians should consider Eagle syndrome when evaluating neck pain. This involves taking a detailed clinical history, conducting a thorough physical examination, using appropriate imaging techniques, and knowing the treatment options. By considering this potential diagnosis, primary care physicians, other healthcare professionals, and physical therapists play an important role in referring these patients to an otorhinolaryngologist or a maxillofacial surgeon for a comprehensive evaluation and management.
  5. Yang Q, Al Mamun A, Hayat N, Md Salleh MF, Salameh AA, Makhbul ZKM
    Front Public Health, 2022;10:889410.
    PMID: 35570961 DOI: 10.3389/fpubh.2022.889410
    Technology plays an increasingly important role in our daily lives. The use of technology-based healthcare apps facilitates and empowers users to use such apps and saves the burden on the public healthcare system during COVID-19. Through technology-based healthcare apps, patients can be virtually connected to doctors for medical services. This study explored users' intention and adoption of eDoctor apps in relation to their health behaviors and healthcare technology attributes among Chinese adults. Cross-sectional data were collected through social media, resulting in a total of 961 valid responses for analysis. The hybrid analysis technique of partial least squares structural equation modeling (PLS-SEM) and artificial neural network (ANN) analysis was applied. The obtained results revealed the significant influence of eDoctor apps in terms of usefulness, compatibility, accuracy, and privacy on users' intention to use eDoctor apps. Intention and product value were also found to suggestively promote the adoption of eDoctor apps. This study offered practical recommendations for the suppliers and developers of eHealth apps to make every attempt of informing and building awareness to nurture users' intention and usage of healthcare technology. Users' weak health consciousness and motivation are notable barriers that restrict their intention and adoption of the apps. Mass adoption of eDoctor apps can also be achieved through the integration of the right technology features that build the product value and adoption of eDoctor apps. The limitations of the current study and recommendations for future research are presented at the end of this paper.
  6. Mohamad Yusof UK, Mashohor S, Hanafi M, Md Noor S, Zainal N
    Data Brief, 2023 Oct;50:109484.
    PMID: 37636134 DOI: 10.1016/j.dib.2023.109484
    Tumorous cancer has been a widely known and well-studied medical phenomenon; however, rare diseases like Myeloproliferative Neoplasm (MPN) have received less attention, leading to delayed diagnosis. Despite the availability of advanced technology in diagnostic tools that can boost the procedure, the morphological assessment of bone marrow trephine (BMT) images remains critical to confirm and differentiate MPN subtypes. This paper reports a histopathological imagery dataset that was created to focus on the most common MPN from the Philadelphia Chromosome (Ph)-negative type, namely Essential Thrombocythemia (ET), Polycythemia Vera (PV), and Primary Myelofibrosis (MF). The dataset consisted of 300 BMT images that can be used to enable computer vision applications, such as image segmentation, disease classification, and object recognition, in assisting the classification of the MPN disease. Ethical approval was obtained from the Ministry of Health, Malaysia and the bone marrow trephine images were captured using a digital microscope from the Olympus model (BX41 Dual head microscope) with x10, x20, and x40 lens types. The development of comprehensive tools deployed from this dataset can assist medical practitioners in diagnosing diseases, thus overcoming the current challenges.
  7. Azman AA, Siok-Fong C, Rajab NF, Md Zin RR, Ahmad Daud NN, Mohamad Hanif EA
    Mol Biol Rep, 2023 Sep;50(9):7909-7917.
    PMID: 37442895 DOI: 10.1007/s11033-023-08661-5
    Triple negative breast cancer (TNBC) is the most aggressive intrinsic breast cancer subtype characterized by the lack of estrogen receptor (ER), progesterone receptor (PR), and low levels of human epidermal growth factor receptor 2 (HER2). The complex nature of TNBC has resulted in little therapeutic progress for the past several decades. The standard of care remains the FEC cocktail (5-fluorouracil (5-FU), epirubicin and cyclophosphamide). However, early relapse and metastasis in TNBC patients persists in causing dismal clinical outcomes. Due to complex heterogeneity features of TNBC, identifying the biomarker associated to the chemoresistance remains a challenge. The emergence of the long non-coding RNA (lncRNA) as a potential signature may have proven to be a new deterrent to diagnostic and treatment options. Previous studies unveiled the associations of lncRNA in the development of TNBCs whereby the aggressiveness and response to therapies may be associated by the abrogation of the molecular mechanism lncRNA. Terminal differentiation induced ncRNA (TINCR) is a lncRNA which have been linked with many cancers including TNBC. The expression and behavior of TINCR may exert unfavorable outcome in TNBCs. Nevertheless, the underlying molecular mechanism of TINCR in driving chemoresistance in TNBC is not well understood. This review will highlight the potential molecular mechanisms of TINCR in TNBC chemoresistance and how it can serve as a future potential prognostic and therapeutic target for a better treatment intervention.
  8. Jusril NA, Mukhtar SM, Abu Bakar SI, Md Saad WM, Wen NK, Adenan MI
    Pharm Nanotechnol, 2023 Aug 31.
    PMID: 37653639 DOI: 10.2174/2211738511666230831122844
    BACKGROUND: Centella asiatica (C. asiatica) has long been traditionally used as a memory enhancer. Nanoemulsion of ethanolic extract C. asiatica (NanoSECA) has been developed to improve brain functions. However, the effect of NanoSECA on enhancing memory and cognitive functions remains unexplored.

    OBJECTIVES: This research aimed to investigate the potential of NanoSECA on cognitive tasks and memory enhancement pathways in a normal adult rat model.

    METHODS: Thirty male Sprague Dawley rats (7-8 weeks old) were randomly subjected to five groups (n=six per group). Treatment groups were supplemented with NanoSECA and ethanolic extract of C. asiatica (SECA) for 28 days by oral gavages. Different brain sections were isolated, homogenized, and tested for acetylcholinesterase, antioxidants (glutathione and malondialdehyde), and anti-inflammatory agents (nitric oxide, tumour necrosis factor-α, and prostaglandin E2).

    RESULT: NanoSECA supplementation markedly enhanced the acetylcholine, glutathione levels and reduced a distinct diminution in plasma activities of acetylcholinesterase, malondialdehyde, nitric oxide, prostaglandin E, and tumor necrosis factor-α levels.

    CONCLUSION: NanoSECA can be used as a memory enhancer through enhanced cholinergic activity, increased antioxidant level, and reduced oxidative stress.

  9. Khan SU, Rahim A, Md Yusoff NI, Khan AH, Tabassum S
    Materials (Basel), 2023 Jul 27;16(15).
    PMID: 37569974 DOI: 10.3390/ma16155267
    There has been an increase in plastic production during the past decades, yet the recycling of plastic remains relatively low. Incorporating plastic in concrete can mitigate environmental pollution. The use of waste polyethylene terephthalate (PET) bottles as an aggregate weakens properties of concrete. An alternative is to use PET bottles as a binder in the mortar. The PET binder mixed with sand results in weak mortar. Marble and iron slag can enhance PET mortar properties by preventing alkali reactions. This study examines the mechanical and durability properties of PET mortar with different mixes. The mixes were prepared as plastic and marble (PM); plastic and iron slag (PI); plastic, sand, and marble (PSM); plastic, iron slag, and marble (PIM); and plastic, sand, and iron slag (PSI). PM with 30-45% plastic content had increased compressive and flexural strength up to 35.73% and 20.21%, respectively. PI with 30-35% plastic content showed strength improvements up to 29.19% and 5.02%, respectively. However, at 45% plastic content, strength decreased by 8.8% and 27.90%. PSM, PIM, and PSI specimens had nearly double the strength of ordinary Portland cement (OPC) mortar. The durability of PET mortar in chemical solutions, mainly 5% HCl and 20% NaOH, indicate that mass decreased after 3, 7, and 28 days. All specimens showed good resistance to HCl and NaCl solutions compared to OPC mortar. However, its resistance to NaOH is low compared to OPC mortar. PET mortar without cement showed higher strength and durability than cement mortar, making it suitable for paver tiles, drainage systems, and roads.
  10. Khairulmunir M, Gani M, Karuppannan KV, Mohd-Ridwan AR, Md-Zain BM
    Biodivers Data J, 2023;11:e104757.
    PMID: 37711366 DOI: 10.3897/BDJ.11.e104757
    The Malayan tiger (Pantheratigrisjacksoni) is a critically endangered species native to the Malaysian Peninsula. To imitate wild conditions where tigers do not hunt every day, numerous wildlife sanctuaries do not feed their tigers daily. However, the effects of fasting on the gut microbiota of captive Malayan tigers remains unknown. This study aimed to characterise the gut microbiota of captive Malayan tigers by comparing their microbial communities during fasting versus normal feeding conditions. This study was conducted at the Melaka Zoo, Malaysian Peninsula and involved Malayan tigers fasted every Monday. In total, ten faecal samples of Malayan tiger, two of Bengal tiger (outgroup) and four of lion (outgroup) were collected and analysed for metabarcoding targeting the 16S rRNA V3-V4 region. In total, we determined 14 phyla, 87 families, 167 genera and 53 species of gut microbiome across Malayan tiger samples. The potentially harmful bacterial genera found in this study included Fusobacterium, Bacteroides, Clostridium sensu stricto 1, Solobacterium, Echerichiashigella, Ignatzschineria and Negativibacillus. The microbiome in the fasting phase had a higher composition and was more diverse than in the feeding phase. The present findings indicate a balanced ratio in the dominant phyla, reflecting a resetting of the imbalanced gut microbiota due to fasting. These findings can help authorities in how to best maintain and improve the husbandry and health of Malayan tigers in captivity and be used for monitoring in ex-situ veterinary care unit.
  11. Othman N, Md Jamil SNA, Masarudin MJ, Jusoh RABM, Alamassi MN
    RSC Adv, 2023 Sep 18;13(40):27965-27983.
    PMID: 37736560 DOI: 10.1039/d3ra04326f
    Less effective antioxidant supplementation in combating free radicals is often related to the lack of the formulation of carriers. The antioxidant may be one of the most powerful substances but is marred by poor uptake by cells when the carrier degraded and dissolved too rapidly. Nanoparticle (NP) systems are promising in overcoming the problem since they provide high surface area to enhance encapsulation and release efficiency. With the right selection of material, NP carriers could function as constructive antioxidant cargos. Generally, NPs carry only one active ingredient; this study, however, utilized chitosan nanoparticles (CNPs) and hydrophobically modified palmitoyl-chitosan nanoparticles (PCNPs) that were dual encapsulated with antioxidants of different polarities, namely, hydrophobic thymoquinone (TQ) and hydrophilic l-ascorbic acid (LAA) to evaluate their combination effects in scavenging free radicals. The antioxidants followed zero-order release kinetics with a controlled release manner for about 48 h. The interaction effects between TQ and LAA loaded in the NP systems were determined by classical isobologram (CI) values. The CI values were derived by a diphenyl picrylhydrazyl (DPPH) assay, a radical scavenging activity assay. Combined TQ and LAA had CI values of less than one, with a lower value in the PCNP system than in the CNP system. This indicates that the interaction between those antioxidants showed higher synergistic effects in PCNPs, which enhanced the DPPH radical scavenging activities. The antioxidative potential of compound(s) encapsulated in the PCNP carrier was further experimented by a reactive oxygen species (ROS) assay on a human normal lung fibroblast cell line (MRC-5) as lung is one of the organs with high accumulation of free radicals. About 48 h post treatment, the dual-loaded TQ and LAA in PCNPs showed the lowest ROS level in comparison to single-loaded antioxidants and bare antioxidant delivery. The hydrogen peroxide (H2O2) radical scavenging was influenced by both the controlled release property of the PCNP system and the synergy between TQ and LAA. In short, dual-loaded TQ and LAA in the hydrophobically modified PCNP had effectively depicted the capability of a single CS-based nanocarrier to hold more than one compound at a time to function as a potent radical scavenger.
  12. Md Hussin NS, Karuppannan M, Gopalan Y, Tan KM, Gnanasan S
    Singapore Med J, 2023 Aug;64(8):497-502.
    PMID: 34600449 DOI: 10.11622/smedj.2021125
    INTRODUCTION: Behavioural and psychological symptoms of dementia (BPSD) are considered integral parts of dementia. While pharmacotherapy is reserved for severe symptoms of BPSD, the associated adverse effects can be detrimental. Therefore, non-pharmacological intervention is recommended as the first line of treatment in the management of BPSD. This study aimed to explore the non-pharmacological approaches for the management of BPSD and the strategies and barriers to implementing them in secondary care facilities in Malaysia.

    METHODS: A qualitative study design was employed. Data were collected through observations and semi-structured interviews of 12 caregivers and 11 people with dementia (PWD) at seven secondary care facilities. Observations were written in the field notes, and interviews were audio-recorded and transcribed. All data were subjected to thematic analysis.

    RESULTS: Some personalised non-pharmacological interventions, such as physical exercise, music therapy, reminiscence therapy and pet therapy, were conducted in several nursing care centres. Collaborative care from the care providers and family members was found to be an important facilitating factor. The lack of family support led to care providers carrying additional workload beyond their job scope. Other barriers to non-pharmacological interventions were cultural and language differences between the care providers and PWD, inadequate staff numbers and training, and time constraints.

    CONCLUSION: Although non-pharmacological approaches have been used to some extent in Malaysia, continuous education and training of healthcare providers and the family members of PWD is needed to overcome the challenges to their successful implementation.

  13. Md Zin SR, Mohamed Z, Alshawsh MA, Wong WF, Kassim NM
    Exp Biol Med (Maywood), 2018 Feb;243(4):375-385.
    PMID: 29237294 DOI: 10.1177/1535370217748574
    Anastatica hierochuntica L. ( A. hierochuntica), a folk medicinal plant, was evaluated for mutagenic potential via in vitro and in vivo assays. The in vitro assay was conducted according to modified Ames test, while the in vivo study was performed according to Organisation for Economic Co-operation and Development guideline for mammalian erythrocyte micronucleus assay. Four groups ( n= 5 males and 5 females per group) Sprague Dawley rats were randomly chosen as the negative control, positive control (received a single intramuscular injection of cyclophosphamide 50 mg/kg), 1000 and, 2000 mg/kg A. hierochuntica aqueous extracts. All groups except the positive control were treated orally for three days. Findings of the in vitro assay showed mutagenic potential of AHAE at 0.04 and 0.2 mg/ml. However, no mutagenic effect was demonstrated in the in vivo study up to 2000 mg/kg. No significant reduction in the polychromatic and normochromatic erythrocytes ratio was noted in any of the groups. Meanwhile, high micronucleated polychromatic erythrocytes frequency was seen in cyclophosphamide-treated group only. These findings could perhaps be due to insufficient dosage of A. hierochuntica aqueous extracts to cause genetic damage on the bone marrow target cells. Further acute and chronic in vivo toxicity studies may be required to draw pertinent conclusion on the safety aspect of A. hierochuntica aqueous extracts consumption. Impact statement In this paper, we report on the mutagenicity evaluation of Anastatica hierochuntica aqueous extract. This is a significant research in view of the popularity of this herb consumption by the people across the globe despite of limited scientific evidence on its toxicity potential. This study is intended to encourage more extensive related research in order to provide sufficient evidence and guidance for determining its safe dosage.
  14. Musa AF, Dillon J, Md Taib ME, Yunus AM, Sanusi AR, Nordin MN, et al.
    J Cardiothorac Surg, 2021 Nov 24;16(1):340.
    PMID: 34819126 DOI: 10.1186/s13019-021-01721-6
    INTRODUCTION: Post-operative atrial fibrillation (POAF) is associated with poorer outcomes, increased resource utilisation, morbidity and mortality. Its pathogenesis is initiated by systemic inflammation and oxidative stress. It is hypothesised that a potent antioxidant and anti-inflammatory agent such as tocotrienol, an isomer of Vitamin E, could reduce or prevent POAF.

    AIMS: The aim of this study is to determine whether a potent antioxidative and anti-inflammatory agent, Tocovid, a tocotrienol-rich capsule, could reduce the incidence of POAF and affect the mortality and morbidity as well as the duration of ICU, HDU and hospital stay.

    METHODS: This study was planned as a prospective, randomised, controlled trial with parallel groups. The control group received placebo containing palm superolein while the treatment group received Tocovid capsules. We investigated the incidence of POAF, the length of hospital stay after surgery and the health-related quality of life.

    RESULTS: Recruitment commenced in January 2019 but the preliminary results were unblinded as the study is still ongoing. Two-hundred and two patients have been recruited out of a target sample size of 250 as of January 2021. About 75% have completed the study and 6.4% were either lost during follow-up or withdrew; 4% of participants died. The mean age group was 61.44 ± 7.30 years with no statistical difference between the groups, with males having a preponderance for AF. The incidence of POAF was 24.36% and the mean time for developing POAF was 55.38 ± 29.9 h post-CABG. Obesity was not a predictive factor. No statistically significant difference was observed when comparing left atrial size, NYHA class, ejection fraction and the premorbid history. The mean cross-clamp time was 71 ± 34 min and the mean bypass time was 95 ± 46 min, with no difference between groups. There was a threefold increase in death among patients with POAF (p = 0.008) and an increase in the duration of ICU stay (p = 0.01), the total duration of hospital stay (p = 0.04) and reintubation (p = 0.045).

    CONCLUSION: A relatively low incidence rate of POAF was noted although the study is still ongoing. It remains to be seen if our prophylactic intervention using Tocovid would effectively reduce the incidence of POAF. Clinical Registration Number: US National Library of Medicine. Clinical Trials - NCT03807037. Registered on 16th January 2019. Link: https://clinicaltrials.gov/ct2/show/NCT03807037.

  15. Li X, Abdullah LC, Sobri S, Md Said MS, Hussain SA, Aun TP, et al.
    Water Air Soil Pollut, 2023;234(5):328.
    PMID: 37200574 DOI: 10.1007/s11270-023-06279-8
    Currently, air quality has become central to global environmental policymaking. As a typical mountain megacity in the Cheng-Yu region, the air pollution in Chongqing is unique and sensitive. This study aims to comprehensively investigate the long-term annual, seasonal, and monthly variation characteristics of six major pollutants and seven meteorological parameters. The emission distribution of major pollutants is also discussed. The relationship between pollutants and the multi-scale meteorological conditions was explored. The results indicate that particulate matter (PM), SO2 and NO2 showed a "U-shaped" variation, while O3 showed an "inverted U-shaped" seasonal variation. Industrial emissions accounted for 81.84%, 58% and 80.10% of the total SO2, NOx and dust pollution emissions, respectively. The correlation between PM2.5 and PM10 was strong (R = 0.98). In addition, PM only showed a significant negative correlation with O3. On the contrary, PM showed a significant positive correlation with other gaseous pollutants (SO2, NO2, CO). O3 is only negatively correlated with relative humidity and atmospheric pressure. These findings provide an accurate and effective countermeasure for the coordinated management of air pollution in Cheng-Yu region and the formulation of the regional carbon peaking roadmap. Furthermore, it can improve the prediction accuracy of air pollution under multi-scale meteorological factors, promote effective emission reduction paths and policies in the region, and provide references for related epidemiological research.

    SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11270-023-06279-8.

  16. Bustam A, Poh K, Shuin Soo S, Naseem FS, Md Yusuf MH, Hishamudin NU, et al.
    Digit Health, 2023;9:20552076231197961.
    PMID: 37662675 DOI: 10.1177/20552076231197961
    OBJECTIVE: Direct urine color assessment has been shown to correlate with hydration status. However, this method is subject to inter- and intra-observer variability. Digital image colorimetry provides a more objective method. This study evaluated the diagnostic accuracy of urine photo colorimetry using different smartphones under different lighting conditions, and determined the optimal cut-off value to predict clinical dehydration.

    METHODS: The urine samples were photographed in a customized photo box, under five simulated lighting conditions, using five smartphones. The images were analyzed using Adobe Photoshop to obtain Red, Green, and Blue (RGB) values. The correlation between RGB values and urine laboratory parameters were determined. The optimal cut-off value to predict dehydration was determined using area under the receiver operating characteristic curve.

    RESULTS: A total of 56 patients were included in the data analysis. Images captured using five different smartphones under five lighting conditions produced a dataset of 1400 images. The study found a statistically significant correlation between Blue and Green values with urine osmolality, sodium, urine specific gravity, protein, and ketones. The diagnostic accuracy of the Blue value for predicting dehydration were "good" to "excellent" across all phones under all lighting conditions with sensitivity >90% at cut-off Blue value of 170.

    CONCLUSIONS: Smartphone-based urine colorimetry is a highly sensitive tool in predicting dehydration.

  17. Mohd Omar R, Ismail IA, Md Yasin M, Ahmad Affandi K, Hasbullah HH, Mohamad Ali ND
    Am J Case Rep, 2023 Aug 23;24:e940594.
    PMID: 37608536 DOI: 10.12659/AJCR.940594
    BACKGROUND Carcinoma of unknown primary (CUP) is a diverse category of malignancies diagnosed in patients who have metastatic disease but without an identifiable primary tumor at initial presentation. CASE REPORT We report a case of CUP which was later diagnosed to be metastatic adenocarcinoma of the breast in a 62-year-old woman. The patient initially presented to a primary care clinic with an incidental finding of a small hard mass in the middle of the sternum, with no other clinical findings in the breast or axillary lymph nodes. Chest X-ray, ultrasound, and CT scan of the sternum suggested a benign sternal lesion, and a mammogram was normal. Due to the persistence of the mass, a biopsy was performed. The histopathological findings revealed a metastatic adenocarcinoma, most likely from breast origin, with positive estrogen receptor (ER) and mammaglobin on immunohistochemistry studies. The patient subsequently underwent PET scan, repeat mammogram, and MRI of the breast. Following high uptake in the rectum on PET, a colonoscopy was performed, revealing a suspicious rectal mass. The mass was surgically excised, and the final histopathological examination concluded the mass was a second primary adenocarcinoma of the rectum. Genetic analyses for BRCA1 and BRCA2 were negative. CONCLUSIONS This is a rare case of an isolated bone-like lesion on the sternum due to metastatic adenocarcinoma of the breast in a patient with no prior history of breast cancer and lacking any clinical or radiological evidence of breast or axillary lymph node lesions on presentation. The patient was also subsequently diagnosed with 2 primary carcinomas. Thorough clinical examination, extensive radiological investigations, laboratory investigations, histopathological examination, and a multidisciplinary approach are essential in managing CUP.
  18. Nawawi FA, Wan Md Adnan WAH, Ismail M, Jalaludin MY, Majid HA
    Kidney Int Rep, 2023 Oct;8(10):1965-1977.
    PMID: 37850001 DOI: 10.1016/j.ekir.2023.07.028
    INTRODUCTION: The health and wellbeing of adolescents are often neglected, including the knowledge of chronic kidney disease (CKD), especially in its early stages.

    METHODS: A total of 607 adolescents were recruited from the Malaysian Health and Adolescents Longitudinal Research Team (MyHeART) study, a prospective cohort study conducted from March 2012 to May 2016 that explored the noncommunicable diseases (NCDs) risk factors among 13 to 17 years old students in 3 states of Peninsular Malaysia. Students who participated in all 3 data collection periods in 2012, 2014, and 2016 with kidney function assessment across all 3-time points were included in the current study. The students' estimated glomerular filtration rate (eGFR) was calculated from isotope-dilution mass spectrometry-traceable Schwartz's equation and categorized based on Kidney Disease: Improving Global Outcomes (KDIGO) classification. Changes in kidney function were examined, and the longitudinal relationship between eGFR and multiple NCD risk factors was analyzed using the generalized estimating equation (GEE).

    RESULTS: The prevalence of decreased eGFR (60-89 ml/min per 1.73 m2) among the students increased from 6.1% (2012) to 30.0% (2014) and 40.2% (2016). Based on the GEE, the student's eGFR decreased over time, with a steeper decline during early to midadolescence. Males and rural students had lower eGFR compared to their counterparts. Students who are morbidly obese had lower eGFR than those with normal body mass index (BMI). Protein consumption also has a potential moderating effect on eGFR in adolescents.

    CONCLUSION: Kidney function changes can be detected as early as adolescence and are likely attributable to multiple NCD risk factors. Therefore, more comprehensive prevention efforts from various stakeholders are needed to identify health issues like CKD.

  19. Ranneh Y, Abu Bakar MF, Ismail NA, Kormin F, Mohamed M, Md Akim A, et al.
    Saudi J Biol Sci, 2021 Dec;28(12):6711-6720.
    PMID: 34866970 DOI: 10.1016/j.sjbs.2021.07.048
    Aging is a naturally biological process with adverse effects. The continuous accumulation of reactive oxygen species (ROS) trigger cellular and tissue damage by activating several aging enzymes. The antioxidant properties of traditional medicinal plants used by Jakun aborigine's community are a promising approach to alleviate aging process and prevent Alzheimer. The aim of the current investigation was to optimize a novel anti-aging formulation from traditional plants (Cnestis palala stem, Urceola micrantha stem, Marantodes pumilum stem and Microporus xanthopus fruiting bodies) using simplex centroid mixture design (SCMD). After selecting the optimal formulations based on desirability function of antioxidant activity (DPPḢ, ABTS ˙ + and FRAP), they were further examined against the activity of aging-related-enzymes (collagenase, tyrosinase, acetyl- and butyrylcholinesterase). The single extracts of C. palala, U. micrantha and the binary mixture of C. palala and U. micrantha were the optimal formulations with high antioxidant activities. Single extract of U. micrantha showed the highest inhibition towards matrix metalloproteinase-1 (49.44 ± 4.11 %), while C. palala water extract showed highest inhibitions towards tyrosinase (14.06 ± 0.31%), acetylcholinesterase (32.92 ± 2.13%) and butyrylcholinesterase (34.89 ± 2.84%) enzymes. The single extracts of C. palala and U. micrantha displayed better activity as compared to the binary mixture formulation. In conclusion, these findings could be a baseline for further exploration of novel anti-aging agents from natural resources.
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