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  1. Fulltext Investigating the in-vitro bioactivity, biodegradability and drug release behavior of the newly developed PES/HA/WS biocompatible nanocomposites as bone graft substitute
    Salimi E, Asim MH, Abidin MNZ
    Sci Rep, 2024 May 11;14(1):10798.
    PMID: 38734777 DOI: 10.1038/s41598-024-61586-2
    The nucleation of carbonate-containing apatite on the biomaterials surface is regarded as a significant stage in bone healing process. In this regard, composites contained hydroxyapatite (Ca10(PO4)6(OH)2, HA), wollastonite (CaSiO3, WS) and polyethersulfone (PES) were synthesized via a simple solvent casting technique. The in-vitro bioactivity of the prepared composite films with different weight ratios of HA and WS was studied by placing the samples in the simulated body fluid (SBF) for 21 days. The results indicated that the the surface of composites containing 2 wt% HA and 4 wt% WS was completely covered by a thick bone-like apatite layer, which was characterized by Grazing incidence X-ray diffraction, attenuated total reflectance-Fourier transform infrared spectrometer, field emission electron microscopy and energy dispersive X-ray analyzer (EDX). The degradation study of the samples showed that the concentration of inorganic particles could not influence the degradability of the polymeric matrix, where all samples expressed similar dexamethasone (DEX) release behavior. Moreover, the in-vitro cytotoxicity results indicated the significant cyto-compatibility of all specimens. Therefore, these findings revealed that the prepared composite films composed of PES, HA, WS and DEX could be regarded as promising bioactive candidates with low degradation rate for bone tissue engineering applications.
  2. Diabetic retinopathy: emerging concepts of current and potential therapy
    Sadikan MZ, Abdul Nasir NA
    Naunyn Schmiedebergs Arch Pharmacol, 2023 Dec;396(12):3395-3406.
    PMID: 37401966 DOI: 10.1007/s00210-023-02599-y
    Diabetic retinopathy (DR) is one of the leading causes of permanent central blindness worldwide. Despite the complexity and inadequate understanding of DR pathogenesis, many of the underlying pathways are currently partially understood and may offer potential targets for future treatments. Anti-VEGF medications are currently the main medication for this problem. This article provides an overview of the established pharmacological treatments and those that are being developed to cure DR. We firstly reviewed the widely utilized approaches including pan-retinal photocoagulation therapy, anti-VEGF therapy, corticosteroid therapy, and surgical management of DR. Next, we discussed the mechanisms of action and prospective benefits of novel candidate medications. Current management are far from being a perfect treatment for DR, despite mild-term favorable efficiency and safety profiles. Pharmacological research should work toward developing longer-lasting treatments or new drug delivery systems, as well as on identifying new molecular targets in the pathogenetical mechanism for DR. In order to find a treatment that is specifically designed for each patient, it is also necessary to properly characterize patients, taking into account elements like hereditary factors and intraretinal neovascularization stages for effective utilization of drugs. The current and potential approaches for diabetic retinopathy. Image was constructed using Biorender.com.
  3. Migratory Fish Bone in the Hyoglossus: Catch Me if You Can
    Musa MA, Hamid IA, Gendeh H
    Cureus, 2024 Apr;16(4):e58215.
    PMID: 38745791 DOI: 10.7759/cureus.58215
    Foreign body ingestion is one of the most frequently encountered cases in otorhinolaryngology and most of the cases can be managed non-operatively. If left untreated, migration of foreign bodies can occur and presents a significant challenge in patient management. We hereby describe the case of an elderly gentleman who had a preceding history of fish bone ingestion and complained of dysphagia for two days. Clinical examination revealed swelling of the right vallecula with minimal pus discharge. Computed tomography (CT) of the neck confirmed the diagnosis of a migratory foreign body in the neck. He underwent open neck exploration and foreign body removal under intraoperative fluoroscopy guidance. A high index of suspicion of a migratory foreign body is warranted in cases of persistent, unresolved symptoms with the failure of endoscopic evaluation to detect the foreign body. Migratory foreign body of the neck may cause life-threatening complications and requires early surgical intervention.
  4. Axillary Metastasis as the Initial Presentation of Recurrent Nasopharyngeal Carcinoma
    Musa MA, Afandi AN, Zahedi FD
    Cureus, 2024 Apr;16(4):e58625.
    PMID: 38770504 DOI: 10.7759/cureus.58625
    The recurrence of nasopharyngeal carcinoma (NPC) is either at the local primary site or at regional or distant metastases. However, an axillary metastasis is a rare entity in NPC. We highlighted a case of recurrent NPC that presented with axillary swelling as the main initial complaint. Clinical examinations showed enlarged left axillary lymph nodes and left cervical lymph nodes. Histopathological examination of the axillary lymph node biopsy confirmed the recurrence of NPC. The patient underwent palliative chemotherapy in view of the advanced stage of recurrent disease. A thorough clinical history and examination during surveillance are crucial for early diagnosis and better survival outcomes.
  5. Self-Practice Program for Beating-Heart Minimally Invasive Coronary Anastomosis Using a Homemade Low-Fidelity Simulator: A Proof of Concept
    Azmi MI, Nair AK, Hashim SA
    Innovations (Phila), 2024;19(2):175-183.
    PMID: 38577864 DOI: 10.1177/15569845241238999
    OBJECTIVE: We evaluated the effectiveness of a consistent and structured self-practice coronary anastomosis program using a homemade low-fidelity beating-heart simulator.

    METHODS: An intermediary trainee was subjected to an 8-week structured self-practice program. The program was divided into 2 parts of nonbeating and beating practices with a minimum number of timed anastomoses. Each part was followed by an assessment using an objective skills assessment tool score. The beating-heart simulator was built using motorized toy blocks connected wirelessly to a smartphone application. This was coded to enable rate selection. A junior consultant was compared to the subject at the end of the program. Both were tasked to perform 1 coronary anastomosis for both off-pump coronary artery bypass (OPCAB) and minimally invasive CAB (MICS) setup. The primary outcomes were anastomotic time and score compared with the junior consultant. Secondary outcomes were progression of anastomotic time and score throughout the program.

    RESULTS: Overall performance of the studied subject approached the performance of the junior consultant in terms of time (OPCAB, 489 vs 605 s; MICS, 712 vs 652 s) and scores (OPCAB, 21 vs 20.7; MICS, 19 vs 20.6). There were inverse correlations between anastomosis time and number of practices for both nonbeating and beating anastomoses. Overall improvement was observed in terms of assessment scoring by 26.6%.

    CONCLUSIONS: A structured self-practice program using an affordable and accessible simulator was able to help trainees overcome the MICS anastomosis learning curve quicker when introduced earlier. This may encourage earlier adoption of MICS among surgeons.

  6. Fulltext Various Ocular Manifestations in Systemic Lupus Erythematosus: A Case Series
    Sharum MH, Sawri Rajan R, Iqbal T
    Cureus, 2024 Mar;16(3):e56503.
    PMID: 38638749 DOI: 10.7759/cureus.56503
    Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disorder with various systemic and ocular clinical manifestations. In patients with SLE, central retinal vein and artery occlusion, choroidopathy, and occlusive vasculitis are among the most significant and clinically relevant ocular manifestations, although they do not commonly occur. We present a case series of three SLE patients of different races and genders who developed ocular-related clinical features of SLE during the course of their systemic disease. The clinical outcomes of each patient were different, affecting their vision in bilateral eyes, with some patients having better visual recovery while others having permanently poor vision. These outcomes were not significantly related to the patients' age, gender, or race.
  7. Fulltext Ingested Australasian Snapper (Chrysophrys auratus) Bone Migration to C5 Vertebral Body
    Mohamed Ramlee FA, Ibrahim N, Hashim MH
    Cureus, 2024 Mar;16(3):e56301.
    PMID: 38629010 DOI: 10.7759/cureus.56301
    Fishbone ingestion has been reported multiple times previously as a cause of oesophageal perforation. This is a surgical emergency that needs to be identified early to ensure immediate medical attention. This report presents the case of a 70-year-old patient with laryngeal perforation and the migration of a Chrysophrys auratus (Australasian snapper) fishbone to the C5 vertebral body. It is hypothesized that the fishbone migrated from the larynx to the visceral fascia and prevertebral fascia before lodging in between the intramuscular substance of the longus coli muscle. Multiple imaging modalities were used to identify and locate the foreign body, including flexible nasopharyngoscopy, esophagogastroduodenoscopy, and a computed tomography (CT) scan of the neck. The exploration of the neck was done by the ENT team and the orthopaedic spine team via the left anterior cervical approach at the level of the C5 and C6 vertebral bodies. The foreign body was identified (15 mm fishbone) at the left lateral of the C5 body, lodged between the intramuscular substance of the longus coli muscle, and was successfully removed.
  8. Cancer treatment - objectives and quality of life issues
    Khan FA, Akhtar SS, Sheikh MK
    Malays J Med Sci, 2005 Jan;12(1):3-5.
    PMID: 22605940 MyJurnal
    The first aim of cancer treatment is to acheive a cure, and when cure is not possible, a good palliation (life prolongation and relief of sufferings) is warranted. This article highlights the aim of cancer treatment and also attempts to assess the issues of quality of life experienced as a result of the disease and its treatment. Palliative therapy should be less intensive than radical treatment and should cause less morbidity than disease itself. It must be effective, completed in a short time and should be tolerable. It is also essential for a physician to give a clear explanation of illness to the patient and realistic advice regarding the likely outcome of therapy and the long and short term morbidities which may occur. The patient may opt for a palliative treatment with a reduced chance of cure but a better quality of life than accepting a radical treatment with a potentially higher degree of morbidity. Quality of life in oncology practice should be seen as a process and as a part of this process it seems sensible to pursue several different lines of questionnaire development rather than constructing one 'perfect" quality of life instrument.
  9. Fulltext Prevalence of Frailty and Its Standardised Assessment Tools among Malaysian Older Person: A Systematic Review
    Shaharudin MI, Abd Rahman NFN
    Malays J Med Sci, 2022 Dec;29(6):34-45.
    PMID: 36818895 DOI: 10.21315/mjms2022.29.6.4
    Frailty is conceptually defined as a state of increased vulnerability in older persons, resulting from age-associated declines in physiological reserve and function as they cope with everyday life stressors. To date, the prevalence of frailty has been assessed in various ways. The objective of this study was to identify the prevalence of the condition and the assessment tools used to determine its occurrence among Malaysian older individuals. A systematic literature search was performed on electronic bibliographic databases, namely, Web of Science, Scopus, EBSCOHost: MEDLINE Complete and Google Scholar. Ten eligible articles were reviewed and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Newcastle-Ottawa Scale. Frailty was diagnosed using Fried's frailty phenotype and the Groningen Frailty Indicator (GFI). Assessment tools that included physical performance tests detected a lower prevalence of frailty than that determined using questionnaire-based tools. The prevalence of frailty ranged from as low as 6% to as high as 76%, and there was a higher prevalence among older persons living in aged care homes. This review suggests increasing prospective and interventional studies on frailty to establish a cause-effect relationship between standardised tools of assessing frailty and its prevalence among Malaysian older persons and provide guidelines for health professionals on promoting active lifestyles among older populations.
  10. Fulltext Regards to the History of Neurosurgery Malaysia: Past, Present and Future
    Ismail MI, Ang SY, Fitzrol DN
    Malays J Med Sci, 2022 Dec;29(6):176-187.
    PMID: 36818908 DOI: 10.21315/mjms2022.29.6.19
  11. Fulltext Interventions to mitigate indoor air pollution: A cost-benefit analysis
    Irfan M, Cameron MP, Hassan G
    PLoS One, 2021;16(9):e0257543.
    PMID: 34559814 DOI: 10.1371/journal.pone.0257543
    Globally, around three billion people depend upon solid fuels such as firewood, dry animal dung, crop residues, or coal, and use traditional stoves for cooking and heating purposes. This solid fuel combustion causes indoor air pollution (IAP) and severely impairs health and the environment, especially in developing countries like Pakistan. A number of alternative household energy strategies can be adopted to mitigate IAP, such as using liquefied petroleum gas (LPG), natural gas, biogas, electric stoves, or improved cook stoves (ICS). In this study, we estimate the benefit-cost ratios and net present value of these interventions over a ten-year period in Pakistan. Annual costs include both fixed and operating costs, whereas benefits cover health, productivity gains, time savings, and fuel savings. We find that LPG has the highest benefit-cost ratio, followed by natural gas, while ICS has the lowest benefit-cost ratio. Electric stoves and biogas have moderate benefit-cost ratios that nevertheless exceed one. To maximize the return on cleaner burning technology, the government of Pakistan should consider encouraging the adoption of LPG, piped natural gas, and electric stoves as means to reduce IAP and adopt clean technologies.
  12. Cervical Laminoforaminotomy for Treatment of Cervical Radiculopathy: A Case Report
    Mohd Yunus MS, Sabri S, Mokhtar SA
    Cureus, 2024 Jul;16(7):e65499.
    PMID: 39188472 DOI: 10.7759/cureus.65499
    Cervical laminoforaminotomy (CLF) provides a safe and effective decompression procedure of nerve roots while maintaining cervical mobility and preserving stability. However, this unique technique requires appropriate patient selection and the technical ability of the surgeon to produce an excellent outcome. Furthermore, anterior cervical discectomy and fusion (ACDF) has been accepted as the "gold standard" procedure in managing cervical radiculopathy, despite posing the risk of anterior structure injuries and fusion. Here we report a case report of the surgical management of unilateral cervical radiculopathy using the CLF technique.
  13. Fulltext Impact of COVID-19 on the connectedness across global hospitality stocks
    Hadi DM, Naeem MA, Karim S
    Int J Hosp Manag, 2022 Jul;104:103243.
    PMID: 35571508 DOI: 10.1016/j.ijhm.2022.103243
    This study investigated the connectedness of top ten hospitality stocks in the world and the impact of the COVID-19 pandemic on this connectedness. For this purpose, we employ the time-varying parameter vector autoregressions (TVP-VAR) to examine the return connectedness among the world's top ten hospitality stocks. We further utilize the wavelet coherence measure to test the impact of COVID-related indexes on the connectedness across the hospitality stocks from January 1, 2020 to July 16, 2021. Our findings explore a strong connectedness among the hospitality stocks, although the total connectedness index is considerably affected by the first wave, the second wave, and the approval of COVID-19 vaccines. France and UK hospitality stocks appeared to be dominant and were the highest net transmitters of spillover shocks to other sample stocks. We document that the COVID-19 pandemic is the prime driver of the hospitality stocks' connectedness during the sample period. Aside from the contribution to hospitality and finance literature, our conclusions and implications can also benefit parties such as hospitality firm managers, investors, portfolio managers, and policymakers.
  14. Fulltext Assessing the role of urban green spaces for human well-being: a systematic review
    Jabbar M, Yusoff MM, Shafie A
    GeoJournal, 2021 Jul 20.
    PMID: 34305268 DOI: 10.1007/s10708-021-10474-7
    Human has been evolving in a natural environment over a long time; thus, he is habitual to adapt it. Green spaces are obligatory landscapes in an urban structure that provide a natural environment and accelerate other life events. In contrast, unplanned urbanization, and conversion from green to grey structures have damaged natural environmental resources. Studies through different angles have highlighted the importance of urban green spaces for human well-being but now need to identify their role according to the potential. The demands of urban green spaces may differ with the change of population size, types of grey structure, urban expansion, the altitude of the place, and geographical location. Therefore, this systematic review aims to analyse the significance of urban green spaces for human well-being. The study opted for a systematic process during the selection and organization of studies for this review. After analysing, 46 studies were finalized with the consensus of three review authors. Accordingly, literature was analysed under the central theme of "Urban Green Spaces for Human Well-being." Human Well-being was assessed under six sub-themes; physical, psychological, mental, social, subjective, and environmental well-being. The review concluded that urban green spaces are the primary pillar for a sustainable urban place and human well-being due to highly positive and positive correlations. Moreover, the study did not find any demarcation line between green spaces and grey structures according to any specific need. Therefore, the study suggested that the role of urban green spaces for human well-being should be analysed according to their potential and required optimal ratio under different communities' urban specific environments and social behaviour.
  15. Waste newspaper as cellulose resource of activated carbon by sodium salts for methylene blue and congo red removal
    Hao YS, Othman N, Zaini MAA
    Int J Biol Macromol, 2024 Oct;277(Pt 4):134353.
    PMID: 39089559 DOI: 10.1016/j.ijbiomac.2024.134353
    The work was aimed at evaluating the adsorptive properties of waste newspaper (WN) activated carbons chemically produced using sodium salts for methylene blue (MB) and congo red (CR) removal. The activated carbons, designated as AC1, AC2, AC3 and AC4 were prepared through impregnation with NaH2PO4, Na2CO3, NaCl and NaOH, respectively and activation at 500 °C for 1 h. The activated carbons were characterized for surface chemistry, thermal stability, specific area, morphology and composition. The AC1 with a surface area of 917 m2/g exhibits a greater MB capacity of 651 mg/g. Meanwhile, a greater CR capacity was recorded by AC2 at 299 mg/g. The pseudo-second order model fitted well with the kinetic data, while the equilibrium data could be described by Langmuir model. The thermodynamic parameters, i.e.., positive ΔH°, negative ΔG° and positive ΔS° suggest that the adsorption of dyes is endothermic, spontaneous and feasible at high solution temperature. To conclude, WN is a potential cellulose source for producing activated carbon, while NaH2PO4 activation could be employed to convert WN into activated carbon for effective dye wastewater treatment.
  16. Fulltext Advances in Titanium Carbide (Ti3C2T x ) MXenes and Their Metal-Organic Framework (MOF)-Based Nanotextures for Solar Energy Applications: A Review
    Fan WK, Sherryna A, Tahir M
    ACS Omega, 2022 Nov 01;7(43):38158-38192.
    PMID: 36340125 DOI: 10.1021/acsomega.2c05030
    Introducing new materials with low cost and superior solar harvesting efficiency requires urgent attention to solve energy and environmental challenges. Titanium carbide (Ti3C2T x ) MXene, a 2D layered material, is a promising solution to solve the issues of existing materials due to their promising conductivity with low cost to function as a cocatalyst/support. On the other hand, metal-organic frameworks (MOFs) are emerging materials due to their high surface area and semiconducting characteristics. Therefore, coupling them would be promising to form composites with higher solar harvesting efficiency. Thus, the main objective of this work to disclose recent development in Ti3C2T x -based MOF nanocomposites for energy conversion applications to produce renewable fuels. MOFs can generate photoinduced electron/hole pairs, followed by transfer of electrons to MXenes through Schottky junctions for photoredox reactions. Currently, the principles, fundamentals, and mechanism of photocatalytic systems with construction of Schottky junctions are critically discussed. Then the basics of MOFs are discussed thoroughly in terms of their physical properties, morphologies, optical properties, and derivatives. The synthesis of Ti3C2T x MXenes and their composites with the formation of surface functionals is systematically illustrated. Next, critical discussions are conducted on design considerations and strategies to engineer the morphology of Ti3C2T x MXenes and MOFs. The interfacial/heterojunction modification strategies of Ti3C2T x MXenes and MOFs are then deeply discussed to understand the roles of both materials. Following that, the applications of MXene-mediated MOF nanotextures in view of CO2 reduction and water splitting for solar fuel production are critically analyzed. Finally, the challenges and a perspective toward the future research of MXene-based MOF composites are disclosed.
  17. Fulltext BNT162b2 vaccine considerations for immunocompromised individuals: A global perspective
    Jatoi HN, Abbas S, Abbasi MS, Tauni MA, Ghazanfar S, Zafar Malick MD, et al.
    Ann Med Surg (Lond), 2022 Jun;78:103796.
    PMID: 35603097 DOI: 10.1016/j.amsu.2022.103796
    With the emergence of COVID-19 vaccines, individuals with comorbidities and immunosuppression require particular attention and should be prioritized for vaccination. However, the majority of vaccine clinical trials excluded people with comorbidities, resulting in a lack of data regarding vaccine efficacy in this demographic. Along with more inclusivity in clinical trials, reaching a definitive conclusion regarding vaccine efficacy in these patients is also crucial. In our review, we highlight the BNT162b2 vaccine safety and efficacy based on the limited number of clinical trials which included this demographic. We also provide vaccine considerations for individuals with cancer, autoimmune diseases, HIV, obesity, diabetes, organ transplant recipients and those undergoing maintenance haemodialysis to help them govern their decision regarding vaccine administration. In conclusion, further studies are required to alleviate any insecurities in patients with comorbidities regarding vaccination and it is recommended that patients are monitored post-vaccination to make sure sufficient immunity is achieved.
  18. Fulltext Diagnostic Accuracy of Machine Learning Models on Mammography in Breast Cancer Classification: A Meta-Analysis
    Hanis TM, Islam MA, Musa KI
    Diagnostics (Basel), 2022 Jul 05;12(7).
    PMID: 35885548 DOI: 10.3390/diagnostics12071643
    In this meta-analysis, we aimed to estimate the diagnostic accuracy of machine learning models on digital mammograms and tomosynthesis in breast cancer classification and to assess the factors affecting its diagnostic accuracy. We searched for related studies in Web of Science, Scopus, PubMed, Google Scholar and Embase. The studies were screened in two stages to exclude the unrelated studies and duplicates. Finally, 36 studies containing 68 machine learning models were included in this meta-analysis. The area under the curve (AUC), hierarchical summary receiver operating characteristics (HSROC) curve, pooled sensitivity and pooled specificity were estimated using a bivariate Reitsma model. Overall AUC, pooled sensitivity and pooled specificity were 0.90 (95% CI: 0.85-0.90), 0.83 (95% CI: 0.78-0.87) and 0.84 (95% CI: 0.81-0.87), respectively. Additionally, the three significant covariates identified in this study were country (p = 0.003), source (p = 0.002) and classifier (p = 0.016). The type of data covariate was not statistically significant (p = 0.121). Additionally, Deeks' linear regression test indicated that there exists a publication bias in the included studies (p = 0.002). Thus, the results should be interpreted with caution.
  19. Fulltext Risk Connectedness Between Green and Conventional Assets with Portfolio Implications
    Naeem MA, Karim S, Tiwari AK
    Comput Econ, 2022 Aug 05.
    PMID: 35966025 DOI: 10.1007/s10614-022-10296-w
    The increasing concerns of investors toward green bonds and their appealing nature of diversification has motivated the current research to study the risk connectedness between green and conventional assets spanning from August 2014 to December 2020. We first estimate the dynamic equi-correlations through DECO-GARCH. Next, we assess the dynamic and static risk connectedness in the median, extreme low, and extreme high quantiles arguing that spillovers vary across different time periods particularly during economically intense time periods. Finally, we analyzed the hedge ratio and hedge effectiveness between green bonds and other assets. We find that equi-correlations are intense during economic shocks such as the Shale oil crisis, Brexit, US interest rate hike, and COVID-19 pandemic. The volatility analysis at average, lower, and upper quantiles also validate time-varying attributes of green and conventional assets. Further, network figures of green and conventional assets identify potential diversification opportunities. Meanwhile, the hedge effectiveness indicates that green bonds are effective hedge for precious metals and cryptocurrencies. Our findings draw multiple implications for policymakers, green investors, financial market participants, and regulatory authorities regarding flight-to-safety during crisis times and maintaining a diverse portfolio to escape potential losses.
  20. Disseminated Cystic-Appearing Lesions in Deep Spaces of the Neck
    Zainal Abidin MH, Mohamad A, Rozhan A
    JAMA Otolaryngol Head Neck Surg, 2024 Nov 14.
    PMID: 39541140 DOI: 10.1001/jamaoto.2024.3886
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