Aims: The antibiofilm activity of endophytic fungus Nigrospora sphaerica CL-OP30 isolated from Swietenia macrophylla King was investigated. Methodology and results: The ability of the fungal endophytic crude extract to impede Streptococcus mutans biofilm formation was preliminarily screened with Congo red agar test. It was proven that S. mutans biofilm formation was hindered on the agar supplemented with the fungal endophytic crude extract. The antibiofilm activity of the fungal endophytic crude extract was evaluated using a microtiter plate method on both initially formed and preformed biofilm. Antibiofilm activity was recorded in a concentration-dependent pattern whereby higher concentrations reduced biofilm formation better than the lower concentrations of extract for both initially formed and preformed biofilm. The architecture of biofilm tested with fungal endophytic crude extract was also observed. Visualization under a light microscope and SEM revealed that the adherence of S. mutans biofilm treated with fungal endophytic crude extract was significantly reduced in both initially formed and preformed biofilm. In addition, observation under SEM showed that the matrices surrounding the bacterial cells were disintegrated and bacterial cells in biofilm completely lost their original shape. The overall data demonstrated that the ethyl acetate N. spaherica CL-OP30 crude extract showed good antibiofilm activity. Conclusion, significance and impact of study The antibiofilm study suggested the potential of N. sphaerica CL-OP30 crude extract against S. mutans biofilm by disrupting the biofilm formation, the disintegration of matrices surrounding the biofilm and responsible for the formation of irregular cell shape. This extract may have a promising potential to be developed as an antibiofilm agent.

Aims: The aquaculture industry has been identified as one of the sources for the emergence of antimicrobial resistant bacteria. This study aimed to determine the level of bacterial contamination from selected catfish pond farming at Jasin, Melaka and its susceptibility to antimicrobial agents. The correlation between the sampling points’ Water Quality Index and the level of bacterial contamination was also determined. Methodology and results : Sampling was carried out at six sampling points of the river as well as selected catfish pond farming. Microbial counts were assessed using the membrane filtration and isolates were further identified by using the polymerase chain reaction (PCR) method. Antimicrobial susceptibility tests were carried out using the disk diffusion method. Results showed that the total bacterial count obtained was not significantly different (P>0.05) between sampling points with an average of 4.47 ± 0.41 log CFU/mL. A total of 27 different bacterial species were identified where 63% were identified as Gram-negative bacteria. A medium negative correlation (r=-6.16, P<0.01) was found between the sampling points’ Water Quality Index and the level of bacterial contamination. Among bacterial species identified, 18 species are pathogenic strains. Conclusion, significance and impact of study Antibiotic susceptibility test indicated that only 4 isolates showed resistance to antimicrobials tested and the study shows the potential cross contamination between fishponds and Kesang River, Melaka. Thus, public health concerns are tangible, and prevention of the cross contamination is crucial for the farm.

Anterior cruciate ligament (ACL) tears are serious knee injuries, whether partial or total. ACL injuries are most typically diagnosed in the clinic settings using a combination of a detailed history, physical examination and corroborated with an appropriate imaging modality. Magnetic resonance imaging (MRI) is highly sensitive for identifying intra-articular knee pathology. This combination has been demonstrated to be effective and non-invasive in diagnosing ACL injury. The reliability of MRI for diagnostic purposes, on the other hand, is not always ideal. This might be due to various factors, including low-quality MRI magnets, post-surgical tissue changes, metallic artifacts, patient movement during procedure, and static rather than dynamic structural evaluation. Nevertheless, office-based diagnostic arthroscopy offers an alternative to imaging modalities by allowing clinicians to visualize large joints safely, painless, high-quality images, and time-efficient approaches. Furthermore, the risk of major and minor complications of office-based diagnostic arthroscopy is comparable to or lower than any standard office-based injection. This is the first office-based needle arthroscopy (OBNA) performed in Malaysia to evaluate intra-articular knee symptoms. Thus, we aim to understand and overview OBNA to identify intra-articular knee pathology by reporting this case report.
Anterior Cruciate Ligament Injuries

Background: To identify determinant(s) and evaluate the relationship between quality of life (QoL) and satisfaction with life (SWL) of the Malaysian elite disabled athletes. Methodology: We conducted a cross-sectional study on 86 disabled athletes located at Pusat Kecemerlangan Sukan Paralimpik Malaysia, Kampung Pandan using universal sampling. Online survey consisting of socio-demographic form, the SWL scale and the World Health Organization QoL short questionnaire were delivered to the athletes of different physical and mental disabilities who participated in adapted sports. Results: A moderately strong correlation was demonstrated between the subdomains of physical health, psychological health, social relationship, and environment of QoL with SWL scale (P ≤ 0.05). Gender and ethnicity were found to be potential determinants of QoL and SWL among these disabled athletes. Conclusions The discrepancies in QoL and SWL between ethnics and gender need solution to ensure inclusivity in disabled sports.
Quality of Life

Aims: The microbial pigment can be the best promising alternative to replace synthetic colorant. However, due to the high cost of synthetic medium for microbial pigment production, there is a need to develop a new low-cost medium of bacterial pigment production. This study aims to investigate the potential of banana and papaya peels as alternative lowcost substrates for a carotenoid-producing bacterium, B12 strain (bacteria strain isolated from Holothuria (Lessonothuria) pardalis). Methodology and results: B12 strain identified as an aerobic bacterium with non-motile, diplobacilli shaped and Grampositive bacteria. The fermentation was optimized with different parameters included the effect of temperature, time, concentrations, pHs, carbon and nitrogen sources to find the optimum relative pigment concentration produced by B12. The results showed that the B12 strain produced the highest relative pigment concentration measured at 450 nm when the strain was cultivated at 37 °C and pH 7 in the culture medium incorporated with the combination of dried papaya peels and banana peels (100% v/v with ratio 1:1) at 72 h of incubation. Lactose, peptone and yeast were observed as the best carbon and nitrogen sources to increase the pigment concentration of B12 strain. Stability of the pigment was studied at different physiochemical stress, and it showed the pigment obtained from dried papaya and banana substrates can tolerate and stable under stress condition. Conclusion, significance and impact of study This can be concluded that the combination of dried papaya and banana peels worked well as substrate and can be utilized as a fermentation medium to replace the synthetic medium which is more expensive and uneconomical for industry application. Besides, it also helps in managing waste and solving the pollution problem due to the increasing of biochemical oxygen demand (BOD) and chemical oxygen demand (COD).
Gram-Positive Bacterial Infections ; Holothuria ; Carica ; Musa

Introduction: This study was carried out to quantify the selected bioactive compounds (i.e., chlorogenic acids, caffeine, and N-methylpyridinium) in instant coffee and to analyze its correlation with the gastric release effect of the HGT-1 cell line. Methods: Selected bioactive compounds in regular (REG), low sugar (LS), low fat (LF), white coffee (WC), white coffee low acid (WCA), decaffeinated (DC), and instant black coffee (BC) were quantified using HPLCDAD (high-performance liquid chromatography diode array detection) system and flow cytometry analysis for its gastric release effect when treated with HGT-1 cell. Results: The HPLC data showed the content of caffeine (60,212 ± 212 µg/ml) and chlorogenic acid (35,779 ± 3027 µg/ml) were significantly high in BC while the lowest caffeine value was found in DC coffee. Chlorogenic acid in other instant coffee samples showed insignificant content distinctions. As for N-methylpyridinium (NMP), the highest content was found in BC (565 µg/ml) and the lowest value was detected in WC (52 µg/ml) coffee. Gastric release activity by HGT-1 cells was significantly higher in DC and REG coffee treatment. Pearson correlation showed no significant correlation between the quantitative data and gastric release activity by HGT-1 cells. Conclusion: The selected bioactive compounds contained in instant coffees were unable to stimulate gastric release.

Introduction: Dengue fever is one of the world’s most severe mosquito-borne diseases, with high morbidity and mortality rate. Poor dengue prevention practices are one of the factors contributing to dengue outbreak. National Health and Morbidity Survey (NHMS) have collected lots of population data on the prevalence of various non-communicable and communicable diseases, including dengue. NHMS 2020 however, focus on communicable diseases i.e., Dengue, Malaria, HIV & Covid-19. Notwithstanding, data on Cognitive, Affective and Behaviour (CAB) domains are scarce. Thus, this study was aimed to develop and validate CAB questionnaire on dengue in Malaysia. Material and Methods: The questionnaire was developed by adapting and improvising similar previous questionnaires used during NHMS 2015, selected published questionnaires, expert panel and literature review. A sample of 200 respondents was used to evaluate the internal consistency of the final instrument. Results: 5 experts reviewed the content validity of the CAB questionnaire while 20 respondents tested its face validity. The Cronbach’s alpha coefficients scores were within the acceptable range from 0.661 to 0.677. Various adjustments were made by deleting items with low Cronbach alpha values in attempt to attain the highest possible alpha values, but further deduction could not be made due to the retention of several important domain-measurement items. Conclusions: The validity and reliability of the CAB-IHBR-Dengue-A-01 questionnaire were of ‘acceptable’ ranges and can be used to assess CAB. The questionnaire is a valid and reliable tool for assessing the CAB’s ability to influence dengue prevention among Malaysians.

Solitary plasmacytoma (SPC) account for only 5% of plasma cell neoplasms, and the literature hardly reports spinal SPC with a neurological deficit. Furthermore, spinal surgical intervention during pregnancy is rarely encountered and often requires multidisciplinary collaboration and management. The objective of this case report is to highlight this near-miss diagnosis and spinal surgical intervention during pregnancy. A 31-year-old woman with 24 weeks gestation presented with sudden paralysis and incontinence, with an underlying history of chronic backpain over a twomonth period. Initially, she was treated for musculoskeletal back pain by obstetric colleagues during an antenatal visit, and no radiograph was performed. A non-contrasted spinal MRI was eventually requested when she started to show bilateral lower limb weakness, numbness and incontinence. The MRI highlighted thoracic vertebrae T11 vertebra plana with kyphotic deformity and a paraspinal soft tissue mass compressing the spinal cord causing spinal cord oedema. Our initial working diagnosis was spinal tuberculosis (TB), considering TB is highly endemic in Malaysia. However, TB workup was negative, and we proceeded with spinal surgery and transpedicular biopsy. Neurology improved significantly after surgery. Eventually, serum protein electrophoresis reported plasma dyscrasia, and HPE confirmed plasmacytoma. The patient was referred to a haematologist for steroidal and chemotherapy treatment.

Objectives: Dengue remains hyperendemic in Malaysia despite extensive vector control activities. With dynamic changes in land use, urbanisation and population movement, periodic updates on dengue transmission patterns are crucial to ensure the implementation of effective control strategies. We sought to assess shifts in the trends and spatial patterns of dengue in Kelantan, a north-eastern state of Malaysia (5°15’N 102°0’E). Methods: This study incorporated data from the national dengue monitoring system (eDengue system). Confirmed dengue cases registered in Kelantan with disease onset between January 1, 2016 and December 31, 2018 were included in the study. Yearly changes in dengue incidence were mapped by using ArcGIS. Hotspot analysis was performed using Getis-Ord Gi to track changes in the trends of dengue spatial clustering. Results: A total of 10 645 dengue cases were recorded in Kelantan between 2016 and 2018, with an average of 10 dengue cases reported daily (standard deviation, 11.02). Areas with persistently high dengue incidence were seen mainly in the coastal region for the 3-year period. However, the hotspots shifted over time with a gradual dispersion of hotspots to their adjacent districts. Conclusions A notable shift in the spatial patterns of dengue was observed. We were able to glimpse the shift of dengue from an urban to peri-urban disease with the possible effect of a state-wide population movement that affects dengue transmission.

Background: Mortality among tuberculosis patients while on treatment is a public health concern in Malaysia. Exploring the risk factors for tuberculosis mortality is important to evaluate the effectiveness of national tuberculosis control programs and to identify vulnerable patients. This study aimed to estimate the 5-year proportion of mortality among tuberculosis patients on treatment and determine its associated factors in Malaysian setting. Methods: A case-control study was conducted between deceased and survived groups in Terengganu state of Malaysia. All notified cases that fulfilled the inclusion and exclusion criteria from 1st January 2016 until 31st December 2020 were included in the study. Descriptive statistics, simple and multiple logistic regressions were employed for data analysis. Results: There were 3,603 tuberculosis cases notified and 12.4% of total notified patients had died during their course of treatment. Multiple logistic regression revealed older age, working group, prison inmate, positive HIV status, far advanced lesion on chest radiographs and disseminated form of tuberculosis were the significant factors associated with mortality among tuberculosis patients with an adjusted odds ratio (AOR) 1.06 (95%CI: 1.04, 1.07; p<0.001); 0.48 (95%CI: 0.33, 0.68; p<0.001); 0.26 (95%CI: 0.09, 0.79; p=0.017); 12.18 (95%CI: 7.15, 20.75; p<0.001); 3.56 (95%CI: 1.46, 8.64; p=0.005); and 6.95 (95%CI: 2.02, 23.97; p=0.002), respectively. Conclusion About 1 in 10 patients had died during the treatment of tuberculosis in Terengganu attributed to the pinpointed socio-demographic and clinical factors. The identified risk factors were useful in improving the current screening programme and clinical management to avert mortality among vulnerable patients.
Tuberculosis