Purpose: Adjuvant radiotherapy (RT), while effective in reducing cancer recurrence and improving survival rates, often comes with radiation toxicity that can adversely affect the patient’s quality of life (QoL). Evaluating toxicity after RT is crucial because it helps to identify and manage adverse effects that can significantly impact a patient’s QoL. By monitoring toxicity, we can adjust treatment plans to mitigate these effects, improve patient comfort, and ensure a better overall outcome. Therefore this study aimed to evaluate and compare QoL following 3D-conformal hypofractionated RT in breast cancer patients. Methods: We included twenty-one Malaysian women with unilateral breast cancer treated with lumpectomy (n=15) or mastectomy (n=6) followed by 3D-conformal hypofractionated RT. QoL was evaluated using the EORTC QLQ-BR45 questionnaire before, during, and after RT. Results: During RT, there was a significant increase in the mean score of the breast symptoms scale compared to baseline (p=0.002), with the most common symptoms being skin problems, followed by swelling and oversensitivity. However, these symptoms were generally mild for most patients. The other quality of life scales remained stable during RT. Post-RT, most QoL scales showed improvements compared to both baseline and during RT, with significant enhancements in the mean breast symptoms score and breast satisfaction score (all p<0.05). Conclusion: Radiotherapy negatively impacted the QoL of our breast cancer patients, specifically on the breast symptoms scale. However, these symptoms improved after 4 months, resulting in high breast satisfaction and indicating a near-excellent cosmetic outcome. Future studies with larger cohorts are essential to validate these findings, as the small sample size (n=21 at baseline; n=13 post-RT) may have limited the detection of more subtle changes

Objective: This study aims to describe histological manifestations and characterise the CDV strain in the tiger to determine its molecular epidemiology and postulate viral pathogenicity. Methods: Histopathology characterisation of the infected tissues were performed through haematoxylin and eosin and immunohistochemistry staining, respectively. We conducted virus isolation and titration in Chinese hamster ovarian expressing the dog signalling lymphocytic activation molecule (CHO-SLAM) cells. Reverse transcription polymerase chain reaction was performed to confirm the presence of CDV RNA, nucleotide and amino acid sequence analyses for comprehensive characterisation of the CDV strain. Results: Notable histopathological changes were observed primarily in the brain, lung, liver, kidney, spleen, and stomach, with viral antigens localised in the lung, liver, kidney, and stomach tissues. CDV-induced cell cytopathic effects yielding 4.27 × 10 6 TCID 50 /mL were observed at 48 h post-inoculation in CHO-SLAM cells. Phylogenetic analysis suggested that the virus originated from the Asia-1 clade. Notably, 549H and 519I mutations in the hemagglutinin protein were observed, indicating adaptation to a non-canid wildlife species. Conclusions and Relevance: Overall, this study enhances our understanding of the molecular characterisation and evolutionary dynamics of the CDV strain present in the Malayan tiger and serves as a benchmark for developing effective preventative measures to protect Malayan tigers and mitigate their risk of extinction.

Dengue remains a public health threat that consumes a significant number of resources for its prevention and control. This systematic review aimed to solidify recent costing evidence in dengue management among South East Asian (SEA) countries. All studies conducted between 2010 and 2020 were retrieved using four international databases i.e. PubMed, Scopus, Web of Science, and Emerald Insight. The review was reported according to PRISMA guidelines. Quality assessments were done independently by two reviewers using a checklist adapted for the cost of illness studies. We identified 13 original articles representing several SEA countries. Among the common reported costing measure include total cost/ health expenditure; direct medical cost; direct non-medical cost; and indirect cost. The estimated total cost for dengue management varied between countries largely due to the difference in the total incidence of dengue cases. The estimated cost spent on dengue per capita GDP ranges from less than 0.001% to 0.1%, depending on the recorded number of dengue cases of the year. The majority of the articles focused on the economic burden from the perspective of treatment such as hospitalization and ambulatory care. In a nutshell, the economic burden of managing dengue infection is costly and the evidence suggests a steady increase in health expenditure with the growing number of dengue cases

Background and Objectives: Malnutrition is a serious public health problem in developing countries, including Indonesia. Based on RISKESDAS 2018, the prevalence of stunting aged 13-15 years in Takalar Regency is 24.83%. This study aimed to assess the prevalence of stunting and the determinants of stunting in adolescent girls aged 13-15 years in the South Galesong District, Takalar Regency. Methods: This is a cross-sectional study using purposive sampling method that included 247 adolescent girls in selected junior high schools. Data collection used questionnaires and anthropometric measurements. An anthropometric measurement was converted to the indices of nutritional status using World Health Organization Anthro Plus software. Results: The prevalence of stunting was 25.1%. Bivariate analysis showed determinant factors related significantly to stunting were energy intake (p<0.001), protein intake (p<0.001), iron intake (p<0.005), and zinc intake (p<0.001). Multivariate analysis showed determinant factors related significantly to stunting were zinc intake (p<0.001, OR=7.993), protein intake (p<0.05, OR=2.248), and knowledge level (p<0.05, OR=2.032). Conclusion The occurrence of stunting is related to the quality and quantity of food and the level of adolescent knowledge about balanced nutrition. It is necessary to hold educational programs and interventions on improving nutrition initiated by stakeholders and the department of health, in this case, the health center is needed to reduce stunting rates, especially among adolescents.
Malnutrition ; Growth Disorders ; Adolescent

Introduction: Food and fitness levels are key factors required to maintain functional life. Hence, nutrition education is crucial in spreading awareness among Sports Science students. There is a paucity of plant-based nutrition knowledge and plantbased culinary skills for fitness locally. Therefore, this study aimed to develop a valid Plant-Based Culinary Nutrition Model (PBCNM) with nutrition knowledge and basic culinary skills to improve fitness among Sports Science students. Methods: This exploratory sequential mixed method study consisted of 2 phases. In Phase 1, a three-round modified Delphi method was conducted with 13 experts to generate a questionnaire that was validated. Lawshe worksheet determined the content validity ratio (CVR) for an item. Content validity index (CVI) for each section and the overall instrument was calculated. In Phase 2, quantitative data collection and analysis addressed the research questions and research gaps leading to model development. A total of 271 undergraduate Sports Science students at higher learning institutions were recruited as respondents. Results: In Phase 1, CVR of the overall survey was 1.0 and CVI was 0.834. Subsequently, the questionnaire was pilot tested for reliability and a Cronbach’s alpha score of 0.836 was obtained for the overall questionnaire. In Phase 2, the respondents’ mean and standard deviation score for the model’s components and needs was 4.21±0.73 for items 1-15. The integration of experts’ perspectives on the need of PBCNM for fitness and feedback from respondents resulted in the development of PBCNM. Conclusion: This study highlighted PBCNM as a helpful guideline for better fitness management.

Madam S, who diagnosed to have stage IV lung adenocarcinoma with exon 21 L858R point mutation (T3N2M1a) was admitted for massive pericardial effusion in April 2016. She was ECOG 4 on admission. Her ECOG improved to 1 after pericardial tapping and initiation of free sample erlotinib 100 mg daily. Repeated CT thorax post treatment showed the disease was partial responded. Due to financial constraints, she had never bought any EGFR-TKI. She was given a free sample of erlotinib intermittently for total of 12 months followed by intermittent afatinib supply for 2 years. Due to this limited supply, she took half doses of afatinib by cutting a 40 mg tablet once every few days to sustain the continuation of cancer treatment. No major side effects were observed and she remained ECOG 0 with good weight gain. Up to her last clinic visit in September 2021, her PFS was more than 5 years. Intermittent doses of EGFR-TKI may prolong PFS in patients with advanced EGFRm+ NSCLC who has limited treatment options.

Periosteum is a connective tissue that envelopes the outer surface of bones and is tightly bound to the underlying bone by Sharpey’s fibers. It is composed of two layers, the outer fibrous layer and the inner cambium layer. The periosteum is densely vascularised and contains an osteoprogenitor niche that serves as a repository for bone-forming cells, which makes it an essential bone-regenerating tissue and has immensely contributed to fracture healing. Due to the high vascularity of inner cambium layer of the periosteum, periosteal transplantation has been widely used in the management of bone defects and fracture by orthopedic surgeons. Nevertheless, the use of periosteal graft in the management of bone defect is limited due to its contracted nature after being harvested. This review summarizes the current state of knowledge about the structure of periosteum, and how periosteal transplantation have been used in clinical practices, with special reference on its expansion.

Introduction: Previous medication adherence studies primarily focused on the domains of non-adherence in hypertension treatment and less attention has been given on domains that encourage adherence to anti-hypertensive medications. The current study is aimed to identify the domains of adherence and non-adherence to anti-hypertensive medications among hypertensive patients in Kuala Lumpur, Malaysia. Methods: Hypertensive patients from two public health clinics in Kuala Lumpur were invited for in-depth interviews until thematic saturation. Audio recordings from these interviews were transcribed verbatim. Transcripts were then analysed deductively with the guidance of the World Health Organization Medication Adherence Framework to extract the domains of adherence and non-adherence to anti-hypertensive medications. Results: Ten patients who were predominantly Malays and aged 34-73 years old participated the study. Patient-related (encompassing knowledge, attitude, belief and culture, lifestyle, personal barriers, self-efficacy, and cue to action), socioeconomic (encompassing social support), condition-related (encompassing nature of illness and presence of multiple co-morbidities), therapy-related (encompassing experience of receiving treatment, barrier in treatment, and side effects of treatment), and healthcare system (encompassing access to healthcare and healthcare center experience) domains were identified as central to the medication-taking behaviour of hypertensive patients. Conclusion: Sixteen codes of adherence and 22 codes of non-adherence to anti-hypertensive medications were identified, which were distributed across five domains (patient-related, socioeconomic, condition-related, therapy related, and healthcare system domains). These findings can help to inform future development of medication adherence questionnaires, individualised interventions for patients with adherence problems, and targeted health promotion programmes to reduce uncontrolled hypertension.

Alzheimer’s disease (AD) is classified as one of neurodegenerative disease caused by neuronal death. It is characterized as memory impairment, including the inability to produce new memories. Since AD has low treatment effectiveness, proteomics research opens possibilities for advancement. Proteomics is the study of proteomes produced by the disease-bearing host to identify and understand diseases. In this case, to investigate the use of protein as a reliable molecular entity and their involvement in AD. Therefore, this review focused on three main applications of proteomics; the potential use of proteomics as a diagnostic tool for AD, the use of proteomics to assess the treatment progression of AD and the advancement in AD research. The review discussed three research areas utilizing the proteomics approach: ageing, behavioural, and demographic research of AD populations. Proteomic approaches have also been shown to be effective to discover the biomarkers for infectious diseases, cancers, heart diseases, and neurological disorders. Although much work remained to be done, the proteomics approach is an interesting method to be carried out in detecting AD at an earlier stage and will be very useful for AD treatment and management in the future.

Discordant lymphoma (DL) is the coexistence of two or more distinct subtypes in separate anatomic sites. There are limited reports on DL cases especially involving more than two subtypes in more than two sites. We report a 76-year-old man who presented with constitutional symptoms, flank mass and painless lymphadenopathies for six months. Laboratory tests revealed moderate anaemia, markedly elevated serum IgM (13400 mg/dL), IgM Lambda paraproteinemia and Lambda light chain paraproteinuria with unmeasurable serum lactate dehydrogenase due to hyperviscous sample. CT scan showed multiple subcutaneous masses over chest wall and retroperitoneum, with lytic bone lesions, and hepatosplenomegaly. Further biopsy findings with morphological, immunohistochemical and molecular analysis of the tissue sections revealed diffuse large B-Cell lymphoma in the chest wall mass, follicular lymphoma in the inguinal lymph node and lymphoplasmacytic lymphoma in the bone marrow. This case highlights the rare DL. The importance of histopathological evaluation of lymphoma despite the availability of PET-CT scans for disease staging is undeniable.