The aim of this study was to determine the polyphenol content and antioxidant activities in commercialized date and pomegranate concentrates that are available in local market. A total of seven samples comprised of two brands of date concentrates (D1 and D2) and five brands of pomegranate concentrates (P1, P2, P3, P4, and P5) have been analyzed for their polyphenol content and antioxidant activity. The Folin-Ciocalteu assay was used to determine the polyphenol content (TPC) of the samples while 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) and Ferric Reducing Antioxidant Power (FRAP) assays were used to determine the antioxidant activity. The results showed the commercialized date concentrate D2 contained the highest TPC (1243.00 ± 67.00 mg GAE/100 ml) and antioxidant activity using FRAP assay (2.67 ± 0.01 mmol TE/100 ml). Date concentrate D1 showed the highest antioxidant activity using DPPH assay (0.39 ± 0.02 mmol TE/100 ml). The pomegranate concentrate P5 showed the highest reading for TPC (3260.10 ± 428.70 mg GAE/100 ml), DPPH (1.61 ± 0.05 mmol TE/100 ml) and FRAP assays (20.98 ± 0.42 mmol TE/100 ml). As a conclusion, the studied commercial date and pomegranate concentrates available in the local market contained high polyphenol and antioxidant contents although the content levels were different from one brand to another. Further study is needed to identify the causes of this distinction. The results of this study could help the consumers to make a better selection of commercialized date and pomegranate concentrates that are available in local market in term of polyphenol content and antioxidant activity.

Background: In a nursing programme, the main objective is to produce nursing graduates who can provide comprehensive care and treatment to the community. A good approach to the systematic design of a learning environment can lead to positive outcomes for graduates. The learning environment is more than student-teacher interaction, teaching and learning activities. Good physical structures and facilities provided by the university are important, too. Furthermore, the university must also be concerned about meeting students’ psychosocial and emotional needs. The aim of this study is to measure the learning environment by administering the Dundee Ready Educational Environment Measure (DREEM) questionnaire to students across the four years of the Bachelor of Nursing programme at the Faculty of Nursing, IIUM, and to identify areas for change that may contribute to a more meaningful student learning experience. Methods: The DREEM questionnaire was administered to 105 Bachelor of Nursing students at IIUM. Results: The total mean score on the 50-item DREEM inventory was 120.12 out of a maximum of 200. Student perceptions of learning and their teachers, their academic self, social self and their perception of the atmosphere were all positive. Eight items with low mean scores (less than two) on the DREEM questionnaire were identified as requiring remediation. Conclusion: The implications include the need to create and maintain a supportive environment, in addition to designing and implementing interventions to remedy unsatisfactory elements of the learning environment if effective and successful teaching and learning are to be realised. Thus, specific remedial steps to improve the student learning environment of the Faculty of Nursing, IIUM are described.

Learning environment in the universities plays an important role in producing highly competent graduates especially in nursing profession. Thus, the most important as-pects are the teaching activities and as well as student – teacher interaction in daily environment in the university. To investigate the International Islamic University Malay-sia (IIUM) nursing students experience towards their teachers and to identify the rela-tionship between teaching and students learning perception in their learning environ-ment. This study used quantitative method and utilized two out of five subscales in Dundee Ready Educational Environment Measurement (DREEM). The subscales used were students’ perception of learning (SPoL) , students’ perception of teacher (SPoT) and total items in these both subscales are 12 and 11 items, respectively. The ques-tionnaire results revealed that IIUM nursing students scored 28.54/48.00 in (SPoL) and 28.13/44.00 in (SPoT). Both findings showed the IIUM nursing students’ experience their teachers and the learning environment are moving in towards positive directions. The regression finding was 51% of the total variation in students’ perception of teacher score was explained by students’ perception of learning. Although the overall sub-scales (SPoL) score in the current study falls in the category of a more positive per-ception, 2 out of 12 items were poorly scored by the IIUM nursing students. The re-searcher strongly agrees that listening to the expression of students is an important consideration for an educational institution. The overall mean score for (SPoT) showed that the students perceived their teachers as moving in the right direction. In this pre-sent IIUM study, one item showed a mean score of less then 2.00. As a result, these two subscales most probably should reflect the same outcome such as in their aca-demic performance and experience greatly during their student life on campus. The arising issues from this DREEM study at IIUM embrace the need for the creation of supportive environment as well as designing and implementing interventions to remedy unsatisfactorily elements of the learning environment for more effective and successful teaching and learning to be realised.

Introduction: The benefits of sufficient fruits and vegetables consumption for health are well known. This study investigated the adequacy of fruit and vegetable intake among older persons and its association with mild cognitive impairment (MCI). The study also identified motivation and barrier factors affecting fruit and vegetables consumption. Methods: A total of 114 respondents aged 60-years and above (25 and 89 respomdents with and without MCI, respectively) from low cost housing areas in Kuala Lumpur participated in the study. Participants were interviewed using a standardised questionnaire with neurocognitive testing scales to determine their cognition level. Results: Of the non-MCI participants, 15.7% met World Health Organisation's (WHO) (2003) recommendations for fruit and vegetable consumption of 400 g/ day compared to 12.0% of the subjects with MCI (p<0.05). Participants without MCI also had a significantly higher intake of fruit and vegetables (281.6 ± 77.2 g/ day) compared to those with MCI (250.4 ± 51.3 g/ day). Total daily intake of vegetables and fruits was significantly correlated with the digit span score of the participants (r=0.214, p<0.02). Total daily intake of leafy green vegetables was correlated with the verbal memory domain score of the total digit span (r=0.254, p<0.01). The main motivating factor for taking fruits, vegetables, and 'ulam' (salad) was their belief in its health benefits. The main barriers to their consumption were dental problems, and a dislike of their taste. Conclusion: Generally, the intake of fruits and vegetables among older persons was inadequate and was associated with poorer cognitive functions. Improvement of oral health status and the provision of more choices of fruits and vegetables for older persons may increase their daily intake.

Introduction: Specific mutations in the epidermal growth factor receptor (EGFR) characterize a subgroup of nonsmall cell lung cancer (NSCLC) patients that may be highly responsive to receptor inhibitor therapy. 18F-FDG PET/CT scans can map the glucose metabolism and treatment response of NSCLC. Therefore, we aimed to assess the pattern of metabolic response and outcome of inoperable NSCLC treated with epidermal growth factor receptor (EGFR) inhibitors, using 18F-FDG PET/CT scan. Methods: A retrospective study of inoperable NSCLC patients on EGFR inhibitor treatment that were referred for wholebody18F-FDG PET/CT scans was conducted based on cases scanned from January 2011 to June 2014. Comparison was made among serial attenuation-corrected fused PET/CT images for all study patients throughout the course of their treatment. Comparison based on PERCIST criteria was categorized into 4 levels ie. complete response (CMR), partial response (PMR), stable disease (SMD), progressive metabolic disease (PMD). Results: Overall, there were 5 patients identified, mean age: 57.4 years old +/- 2.9 years; The median survival time from initiation of EGFR inhibitor treatment to death was 17 months. Two patients showed initial partial metabolic response (PMR), two had progressive metabolic disease (PMD) and one had complete metabolic response (CMR) after the initiation of treatment. The patient with initial CMR had relapse and PMD 5 months later. Majority of patients eventually succumbed to their illness. Conclusions: Wholebody18F-FDG PET/CT is able to assess metabolic treatment response of NSCLC towards EGFR inhibitor treatment.
Lung Neoplasms ; Carcinoma, Non-Small-Cell Lung

With increasing number of dengue cases in Malaysia, it’s of utmost importance that immediate action be taken to limit the epidemic. Since dengue control is a behavioral problem, the knowledge, attitude and practice in population needs to be studied in order to control the disease. Hence, the aim of this study is to assess knowledge, attitude and practice regarding dengue and its associated factors among adult residents of Felda Sungai Panching Timur (SPT), Kuantan, Pahang, 2014. Method: A cross sectional study was carried out involving 265 adult respondents. A face to face interview questionnaire which was divided into 2 parts (Part A: Sociodemoghraphic; Part B: Knowledge, Attitude and Practice) was used. Data was analyzed using descriptive statistics, simple and multiple logistic regression. Results: 53.2% of the respondents had good knowledge about dengue and it was found that the main source of information from mass media (76.6%). However, only 43.4% were found to have good attitude towards dengue. Multiple Logistic Regression analysis showed there was no association between sociodemographic characteristics with the level of knowledge and attitude towards dengue. There was also no association found between knowledge of dengue and the attitude of the respondents towards dengue. Descriptive analysis on the practice of dengue showed majority of the respondents who had possible breeding site for Aedes mosquitos (water container, drains/gutter roof/flower pots/tires) in their compound practiced good habit in preventing the Aedes mosquitoes from breed. Conclusion: Although knowledge and practice towards dengue is good, their attitude require improvement.

The Integrated Medical Response protocol (IMP) is a new protocol of medical response during the response phase of a flood disaster in Kelantan, Malaysia. It integrates response workflows of various rescue agencies involved in patient care during response phase of flood disaster. Traditionally, health care services in this region used either an all-hazard protocol or those not specific to Kelantan. The present study is aimed to test the effectiveness of IMP on knowledge, attitude and practice of healthcare providers (HCP) involved in managing patients during flood disaster in Kelantan. This study was a prospective parallel group, single blinded, randomized controlled trial. The unit of randomization was the district within Kelantan on a 1:1 basis into either the control or intervention group using cluster randomized method. The hospitals within the district were subsequently assigned to the allocated group. Investigators were blinded to the assignments. The knowledge, attitude and practice scores of HCP were assessed by FloodDMQ-BM© and was evaluated 2 weeks before and immediately after a flood disaster table-top exercise. Data was analyzed using two-way repeated measure ANOVA. Our findings showed that intervention was essential to improve the knowledge [F (1,100) = 6.947, p-value 0.010 (<0.05)] and attitude scores [F (1,100) = 31.56, p-value 0.001]. Meanwhile, practice score was improved in both control and intervention group with time [F (1,100) = 226.56, p-value 0.001]. Thus, our localized IMP specific to response phase of flood disaster was crucial to further enhance the knowledge and attitude levels among HCP while practice level showed similar improvement in both control and intervention group post table-top exercise.

Rheumatic heart disease is still endemic in developing countries and among the indigenous population in developed countries. However, there is no comprehensive data on rheumatic heart disease patients in Malaysia. The Cardiology Department of Queen Elizabeth ll Hospital (QEH ll), Sabah started this hospital-based registry in 2010. The objective of this analysis was to report the demographic profile, severity of disease, types of valve involvement and the practice of secondary prophylaxis among these patients. This was a retrospective record review involved a three-year review of patients registered under the rheumatic heart disease registry in QEH ll, Sabah from December 2010 to November 2013. It included patients who attended the cardiology clinic who were diagnosed with rheumatic heart disease. A total of 627 rheumatic heart disease patients were registered over a period of three years. Mean age was 41 (16.2) year old, 67.5% were female, and 51.2% of the patients had severe valvular dysfunction with mitral regurgitation as the commonest valve affected (67.3%). There was an increasing trend in the percentage of patients receiving secondary prophylaxis (oral and intra-muscular) from the year 2010 to the year 2013 (23.2% and 67.6% respectively). Abnormal ECG, pulmonary regurgitation and not on any secondary prophylaxis were found to be associated with severe rheumatic heart disease. Rheumatic heart disease is prevalent in Sabah. Most patients had severe form of valve dysfunction when diagnosed. Awareness and advocacy on secondary prophylaxis warrant immediate improvement.

Introduction: Neisseria meningitidis infections often cause severe meningitis as well as bacteraemia. However, cellulitis in meningococcal diseases have rarely been described. Here, we report a case of right lower limb cellulitis caused by N. meningitidis. Case Report: A 69-year-old woman presented with fever and lower limb swelling. She had diabetes mellitus, hypertension, dyslipidaemia and a history of surgical resection of vulvar carcinoma. N. meningitidis was isolated from her blood culture. Discussion: This report provides additional evidence in support of N. meningitidis as a cause of cellulitis.

secondary medical impairment following spinal cord injury(SCI). Ultrasound (US) of the kidneys, ureters and bladder(KUB) has been recommended as a useful, non-invasivesurveillance method with good diagnostic sensitivity. Thisstudy aims to understand US diagnosed NB complicationsand identify its associated factors.Methods: We enrolled all patients referred for SCIrehabilitation from 2012 to 2015 that fulfilled our studycriteria. Data that were retrospectively reviewed includeddemographic and clinical characteristic data; and US KUBsurveillance studies.Results: Out of 136 electronic medical records reviewed, 110fulfilled the study criteria. The prevalence of NB in our studypopulation was 80.9%. We found 22(20%) of the patientsshowed evidence of US diagnosed NB complications withthe mean detection of 9.61±7.91 months following initial SCI.The reported NB complications were specific morphologicalchanges in the bladder wall 8(36.4%); followed byunilateral/bilateral hydronephrosis 7(31.8%); bladder and/orrenal calculi 5(22.7%); and mixed complication 2(9.1%)respectively. Half of the patients with NB complications hadurodynamic diagnosis of neurogenic detrusor overactivitywith/without evidence of detrusor sphincter dyssynergia.We found co-existing neurogenic bowel, presence ofspasticity and mode of bladder management weresignificantly associated factors with US diagnosed NBcomplications (p<0.05), while spasticity was its predictorwith adjusted Odds Ratio value of 3.93 (1.14, 13.56).Conclusion: NB is a common secondary medical impairmentin our SCI population. A proportion of them had USdiagnosed NB complications. Co-existing neurogenic bowel,presence of spasticity and mode of bladder managementwere its associated factors; while spasticity was itspredictor.