Introduction: Cosmos caudatus (Ulam Raja) is rich in phytochemicals and can be utilised in diet diversification strategies to improve the health of individuals. This study was designed to incorporate dry and aqueous extracts of C. caudatus for the preparation of herbal noodles. Methods: For this purpose, different proportions of dry extract (2, 4 and 6% dry extract) and aqueous extract (5, 10 and 15% aqueous extract) of C. caudatus were used. The physicochemical properties of noodles evaluated were pH, cooking time, cooking loss, texture and colour. Total polyphenol contents (TPC) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay were carried out to assess the antioxidant potential. Lastly, sensory appraisal of functional noodles was carried out to assess consumer acceptance and marketability. Results: The results on physicochemical properties indicated that the pH value of noodles varied from 8.66 to 10.47. In terms of textural analysis and colour properties, firmness and greenness (a*) were higher in dry extract noodles. TPC varied between 115 to 149 mg gallic acid equivalents (GAE/100g) whilst the highest DPPH free radical inhibition was exhibited in herbal noodles prepared using 4% dry extract (92.8%). In contrast, in terms of sensory appraisal, herbal noodles prepared with aqueous extract were more acceptable than dry extract noodles. Conclusion: C. caudatus can be utilised to prepare herbal noodles thus enhancing the dietary intake of phytochemicals especially antioxidants. Such functional foods can improve the health of consumers and offer the potential of protection against various ailments.

Although nasopharyngeal carcinoma (NPC) is common in this part of the world, the incidence among children is still very low worldwide. The diagnosis is sometimes delayed because of the late reporting of the symptom by the patient or parents, or difficulty in reaching the final diagnosis due to its hidden anatomical location. The challenges include the difficult endoscopy in children, inability to differentiate an adenoid from the tumour on radiograph and often the inconclusive fine needle aspiration findings. If the tumour mass at Fossa of Rosenmuller can be clearly appreciated and biopsied with undoubtedly proven histology of NPC, the diagnosis can be straight forward and treatment can be commenced as early as possible. We report a 10-year-old child presented with bilateral neck cervical lymphadenopathy and epistaxis with fine needle aspiration cytology (FNAC) of the neck mass reported as lymphoma. Further work-up confirmed he was suffering from NPC.

Falls are major public health issues which highly associated with older adults worldwide. Falls can cause a negative debilitating effect on the individual and may lead to fatal injury in certain cases. Current studies on falls characteristics are limited in Malaysia. The aim of this study was to pool the current studies conducted in Malaysia regarding the fall and its characteristics. Articles were identified by using the following electronic databases; EBSCOhost, ClinicalKey, ScienceDirect, Wiley Online Library, SpringerLink and Google Scholar. Article identification was limited to English language which were published between 2013 to 2019. This study looked into older adults aged 60 years old and above; conducted either in a residential, community-dwelling or medical institute. A total of nine articles was identified and investigated. Studies indicate a huge variation in the prevalence falls among older adults in Malaysia ranging between 4-74%. A study that was conducted in the community indicated lower prevalence of falls. Majority of the falls occurred in the morning as reported by three studies which covered and ranged between 49-64.7%. Indoor accounted as the highest number of falls in term of location and ranged between 50-87% while outdoor falls were between 13-49.3%. Location in bathroom and toilet had the highest percentage of indoor falls. Fallers that sustained injury ranged between 47-82%. A variation on the fall prevalence among older adults was determined by factors such as location and existing medical conditions. Pooled information in our study indicates that there is lack of standardised measuring tools for falls characteristics in Malaysia. There is a need for large scale longitudinal prospective study to establish the prevalence and the causal-effect relationship of falls in Malaysia.

In recent years, there is a growing enthusiasm in honey which has potential health benefits, disease prevention and serves as substitution of modern medicine. Honey is a natural sweet product which is produced by honey bees from floral nectar and has been traditionally used to treat several diseases such as cardiovascular disease, diabetes mellitus, cancer and Alzheimer’s disease since ancient times. Gelam honey (GH) is one of the Malaysian wild monofloral honey which is widely used as traditional medicine by the local population. GH is enriched with several therapeutic properties namely, antioxidative, antiinflammatory, anticancer and accelerated wound healing activities. However, there is lack of literature focusing on the overall effects of GH and its medicinal value. This review paper summarises the phytochemistry characteristics of GH along with its therapeutic values which lead to a broad spectrum idea on several diseases. A concise clarification on the therapeutic properties of GH is expected to provide new knowledge to thescientific society in these modern globalization eras.
Wound Healing

Many of our chronic kidney disease (CKD) patients venture into complementary and alternative medicine (CAM) to seek a cure for the disease beyond conventional management. The objective of this study was to determine the prevalence and pattern of CAM usage; and its association with the progression of CKD in our population. This was a cross-sectional survey recruited CKD patients from Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Data was collected via interview using questionnaires which explore the demographics, type and pattern of CAM use. Patients’ comorbidities and serum creatinine were extracted from the medical notes to assess the association between progression of CKD and usage of CAM. Chi-square, Independent Samples t-test, Mann-Whitney U test and logistic regression were used to evaluate for an association. Three hundred and seventy two eligible patients were recruited. The prevalence of CAM use was 29% in the past year. Younger age, higher education and higher income level were associated with significantly more usage of CAM. Natural products were the commonest type of CAM used (86.1%). The belief in the effectiveness of CAM was the main reason for its uptake and about 57.8% revealed their practice to their physician. We found that the use of CAM in Malaysian CKD patients did not influence the progression of the disease.

Drowning is one of 10 leading causes of death in every region of the world especially in the picnic and recreation. Statistics from Fire and Rescue Department showed an average of 700 people drown each year in this country. There were also cases where casualty to rescuers during the Save and Rescue Operation (SAR). As the incidents increased, the task of rescuers and equipment used should be reviewed. Issue How to ease rescuer task and safely lift underwater drown body. Problem Statement Difficulties arise during lifting drown body from underwater to the surface due to certain circumstances. This involved safety to rescuers, process of rescuing and time consuming of the operation. Objective The objective of this study is to determine the efficient ways of lifting drown body based on rescuers preferences. From the results, new stretcher design parameters will be established. Method Thirty rescuers from two Water Rescue Teams namely PPDA Putrajaya and PPDA Shah Alam Branches participated in this study. They are 24 male and 6 female aged between 23 to 51 years with mean of age at 29.5 year and experienced in SAR. Instrument Questionnaires were used to identify factors contributed to success or failure of any SAR operation. Likert scale questions were used to measure their preferences. Data then processed using statistical software (SPSS). Results Findings shows that all respondents agreed that lifting method is the most significant factor affecting their task performance, safety and time consumes. Meanwhile 83.3% of them strongly agreed and 16.7% agreed the usage of proposed floatable stretcher to lift drown body in their future SAR Operations.

Background: Antiphospholipid syndrome (APS) is a multisystem disease that may present as venous or arterial thrombosis and/or pregnancy complications with the presence of antiphospholipid antibodies. Until today, heterogeneity of pathogenic mechanism fits well with various clinical manifestations. Moreover, previous studies have indicated that genes are differentially expressed between normal and in the disease state. Hence, this study systematically searched the literature on human gene expression that was differentially expressed in Obstetric APS. Methodology: Electronic search was performed until 31st March 2015 through PubMed and Embase databases; where the following Medical Subject Heading (MeSH) terms were used and they had been specified as the primary focus of the articles; gene, antiphospholipid, obstetric, and pregnancy in the title or abstract. From 502 studies retrieved from the search, only original publications that had performed gene expression analyses of human placental tissue that reported on differentially expressed gene in pregnancies with Obstetric APS were included. Two reviewers independently scrutinized the titles and the abstracts before examining the eligibility of studies that met the inclusion criteria. For each study; diagnostic criteria for APS, method for analysis, and the gene signature were extracted independently by two reviewers. The genes listed were further analysed with the DAVID and the KEGG pathways. Results: Three eligible gene expression studies involving obstetric APS, comprising the datasets on gene expression, were identified. All three studies showed a reduction in transcript expression on PRL, STAT5, TF, DAF, ABCA1, and HBEGF in Obstetric APS. The high enrichment score for functionality in DAVID had been positive regulation of cell proliferation. Meanwhile, pertaining to the KEGG pathway, two pathways were associated with some of the listed genes, which were ErBb signalling pathway and JAK-STAT signalling pathway. Conclusion: Ultimately, studies on a genetic level have the potential to provide new insights into the regulation and to widen the basis for identification of changes in the mechanism of Obstetric APS.

Inflammatory Pseudotumor (IP) of bladder is one of a variety of lesions which may arise from spindle cell lesions in the bladder. It is benign in nature compared to the other end of the spectrum of spindle cell lesions, such as sarcoma, sarcomatoid carcinoma and leiomyosarcoma. The diagnosis of IP and its differentiation from a malignant pathology is a diagnostic dilemma for Urologist and Pathologist as both entities share certain similar morphological and histo-pathological appearance as well as immuno-histo chemistry staining. It is however crucial to avoid misdiagnosis as the treatment option varies significantly between a radical or partial cystectomy with future surveillance cystoscopes. Hereby, we highlight a case of a benign variant of spindle cell tumour of bladder which needed second pathology review for confirmation and thus avoiding a radical cystectomy. We also review the literature on its presentation and emphasis characteristics differentiating a benign from a malignant pathology.

Clinical experience with extensively Drug Resistant tuberculosis (XDR-TB) has not been reported in Malaysia before. We describe the clinical characteristics, risk factors, progress and therapeutic regimen for a healthcare worker with XDR-TB, who had failed therapy for multidrug resistant TB (MDR TB) in our institution. This case illustrates the risk of TB among healthcare workers in high TB-burden settings, the importance of obtaining upfront culture and susceptibility results in all new TB cases, the problem of acquired drug resistance developing during MDR-TB treatment, the challenges associated with XDR-TB treatment regimens, the value of surgical resection in refractory cases, and the major quality of life impact this disease can have on young, economically productive individuals.
Extensively Drug-Resistant Tuberculosis

Aims: Polyvinyl chloride (PVC) is the most widely used and environmentally damaging plastic. Processing, production and disposal of PVC cause release of toxic chlorine based compounds into environment. The objective of the present study was to assess the biodegradability of cellulose blended PVC by white rot fungi i.e. Phanerochaete chrysosporium. Methodology and results: Biodegradability of the strain for the polymer was tested on plate assay, sturm test, soil burial and shake flask experiments. The biodegradability of the polymer was determined by visual changes, plate assay and carbon dioxide production. Morphological changes in the polymer such as pits, extensive spotting, clear surface erosion, fungal attachment, roughening and deterioration of some parts were observed using scanning electron microscopy. Chemical changes like appearance and shortening of peaks using fourier transform infrared spectroscopy also confirmed the biodegradability of the polymer. Conclusion, significance and impact of study: The present study confirmed that mixing of small amount of cellulose increases the hydrophilicity of the polymer and lead to its microbial degradation and Phanerochaete chrysosporium has great potential for the treatment of solid waste containing plastics.