The increasing number of homeless children is concerning. This study aimed to assess the dietary intake, diet quality, and nutritional status of homeless children in Klang Valley, as well as the relationship between diet quality and nutritional status. Methods: Approximately 120 homeless children aged 7 to 12 years from four locations in Klang Valley were enrolled. Their dietary intake and nutritional status were assessed using a two-day 24-hour dietary recall and body mass index-for-age, respectively. The Healthy Eating Index (HEI) was used to examine diet quality. Results: Prevalence of normal weight respondents was 58.3% (mean±SD: -0.79±1.80), with 25.0% classified as moderately and severely thin. Mean energy intake was significantly lower than recommended nutrient intakes (RNI) (p<0.050), while protein intake was higher (p<0.050). Calcium and zinc intakes were also significantly lower (p<0.001). Boys aged 7-9 years had significantly higher iron intake (median=11.6, IQR=8.7 mg, p=0.003), whereas girls aged 10-12 years had significantly lower intakes of iron (mean±SD=11.4±5.1, 11.1±4.7) and vitamin A (median=416.6, IQR=450.4 µgRE, p<0.001 for both). Mean HEI score was 51.30±6.78, indicating a need for diet quality improvement. No significant association between diet quality and nutritional status was observed (p=0.380). Conclusion: This study provided insights into dietary intake, diet quality, and nutritional status of homeless children. Further research is vital to shape evidence-based nutrition interventions.

Introduction/Objective: The management of potential treatment-related complications and bleeding events in haemophilia is challenging in developing countries. Providing optimal care among these patients improve their quality of life (QOL) and life expectancy. This study explores the demographic characteristics and treatment outcome in a major haemophilia treatment centre in Malaysia. Materials and Methods: A total of 260 patients were recruited in this retrospective cross-sectional analysis. Clinical data, including treatment regimens and outcome, were collected and analysed. Results: A total of 211 patients were diagnosed with haemophilia A (HA) (severe disease, 72.5%) and 49 patients had haemophilia B (HB) (severe disease, 65.3%). The median age was 31 (IQR;2-84) years. Majority of the patients had at least one episode of musculoskeletal bleeding since diagnosis. The mean annual bleeding event (ABE) was 4.91 (SD±6.07) in 2018. Target joints were identified in 80.4% of the patients. Chronic arthropathy and synovitis collectively accounted for more than half of the musculoskeletal complications. 30.1% of the patients had contracted hepatitis C with less than half received treatment. Thirty-one patients (16.8%) with severe haemophilia developed inhibitor and 12 patients successfully underwent immune tolerance induction. More than three-quarters of the severe haemophilia patients were treated with factor concentrate prophylaxis. The mean prophylaxis dose for HA and HB were 41.3 (SD±19.1) and 48.6 (SD±21.5) IU/kg/week, respectively. In patients with severe disease, prophylaxis significantly reduced the ABE (5.45,9.03;p=0.005). Conclusion: The importance of utilising a low to moderate dose regimen as prophylaxis in haemophilic patients is highlighted in our study. Future studies should include QOL assessment will further improve the management in haemophilia.

This study aims to elucidate the antiproliferative mechanism of hydroxychavicol (HC). Its effects on cell cycle, apoptosis, and the expression of c-Jun N-terminal kinase (JNK) and P38 mitogen-activated protein kinase (MAPK) in HT-29 colon cancer cells were investigated. HC was isolated from

Introduction: This study aimed to determine the views and practices of healthcare providers and barriers they encountered when implementing the national health screening program for men in a public primary care setting in Malaysia. Methods: An online survey was conducted among healthcare providers across public health clinics in Malaysia. All family medicine specialists, medical officers, nurses and assistant medical officers involved in the screening program for adult men were invited to answer a 51-item questionnaire via email or WhatsApp. The questionnaire comprised five sections: participants’ socio-demographic information, current screening practices, barriers and facilitators to using the screening tool, and views on the content and format of the screening tool. Results: A total of 231 healthcare providers from 129 health clinics participated in this survey. Among them, 37.44% perceived the implementation of the screening program as a “top-down decision.” Although 37.44% found the screening tool for adult men “useful,” some felt that it was “time consuming” to fill out (38.2%) and “lengthy” (28.3%). In addition, ‘adult men refuse to answer’ (24.1%) was cited as the most common patient-related barrier. Conclusions: This study provided useful insights into the challenges encountered by the public healthcare providers when implementing a national screening program for men. The screening tool for adult men should be revised to make it more user-friendly. Further studies should explore the reasons why men were reluctant to participate in health screenings, thus enhancing the implementation of screening programs in primary care.

Piper betle (PB), also known as "betel" in Malay language, is a tropical Asian vine. PB leaves are commonly chewed by Asians along with betel quid. It contains phenols such as eugenol and hydroxychavicol along with chlorophyll, β-carotene, and vitamin C (Salehi et al., 2019). Extracts from PB leaves have various medicinal properties including anticancer, antioxidant, anti-inflammatory, and antibacterial effects (Salehi et al., 2019). Previous research has shown that PB induces cell cycle arrest at late S or G2/M phase and causes apoptosis at higher doses (Wu et al., 2014; Guha Majumdar and Subramanian, 2019). A combination of PB leaf extract has also been shown to enhance the cytotoxicity of the anticancer drug, 5-fluorouracil (5-FU), in cancer cells (Ng et al., 2014).
Antineoplastic Agents, Phytogenic/pharmacology* ; Cell Movement/drug effects* ; HT29 Cells ; Humans ; Microtubules/drug effects* ; Piper betle ; Plant Extracts/pharmacology* ; Plant Leaves

Cryptococcal infections commonly occur in immunosuppressed patients and are uncommon in immunocompetent persons. Patient concerns: A 32 year old lady, active smoker presented with right chest pain, dry cough and loss of weight. Initial chest radiograph showed a lobulated lung mass in the right lower lobe. She developed headache and right cranial nerve palsy during admission. Various investigations were done including lumbar puncture, brain and chest imaging. Diagnosis: Cryptococcal meningitis with pulmonary cryptococcoma. Interventions: She received five months of effective antifungal treatment; however, the patient did not respond well. Subsequently, removal of pulmonary cryptococcoma was done. Outcomes: Her condition improved and she no longer had any headache. Lessons: Disseminated cryptococcosis is rare in immunocompetent patient. Our case highlights the importance of high index of suspicion and we postulate that lobectomy helped in reducing the cryptococcal burden in her body, thus facilitating better response to antifungal therapy.

This is a case report of subcutaneous mycosis presenting as a non-healing left calf ulcer in an immunocompromised patient. Traumatic inoculation of the causative agent is the most likely route of infection. The diagnosis requires a detailed history and high clinical suspicion, confirmed by histopathological examination. The management requires a multidisciplinary team approach involving surgeon, pathologist, physician sub-specialised in infectious disease, wound care nursing team as well as social support services. The literature review recommended that the treatment of choice for such infection is surgical debridement in addition to optimal antifungal therapy.
Mycoses

INTRODUCTIONThe precise burden of movement disorder conditions in our movement disorders centre is unclear. This study investigated the clinical burden of the Movement Disorders Clinic (MDC) in National Neuroscience Institute (NNI) over 10 years, aiming to identify the burden and spectrum of movement disorders conditions, to facilitate future resource allocation.

MATERIALS AND METHODSWe identified all patient visits from January 2002 to December 2011 at MDC from the Movement Disorders (MD) database using a standardised data collection form.

RESULTSThere was a linear increase in the clinical burden of MDC during this period. Parkinsonism comprised 71.6% of this clinical burden of which 84.8% were Parkinson's disease (PD) patients. Dividing the incident cases of MD conditions into two 5 years' blocks, the proportion of PD cases had not changed. There was significant increase in time to diagnosis for PD, hemifacial spasm and dystonia.

CONCLUSIONThere was nearly 4-fold increase in the burden of movement disorders conditions in our tertiary condition within a decade. However, we did not find increasing proportion of PD cases which would be in line with an ageing population. This could be due to the fact that we are still in the early stages of an ageing population and we postulate that this proportion will go up in the future. The increased time to diagnosis may indicate increasing waiting time to see a movement disorders specialist and that current outreach effort to promote awareness may not be reaching its target audience. The upward trend of clinical burden indicates a need for increased resource allocation to cope with demand for movement disorders services.

Aged ; Cost of Illness ; Female ; Humans ; Male ; Middle Aged ; Movement Disorders ; epidemiology ; Retrospective Studies ; Tertiary Care Centers ; Time Factors

INTRODUCTIONTraditional Chinese Medicine or Traditional Complementary Medicine (TCM) is commonly used in our culture. There are several concerns regarding its use in patients undergoing conventional treatments for breast cancer. In this study, we aimed to evaluate the prevalence and pattern of TCM use among our breast cancer patients, and to identify patients who were most likely to choose TCM.

MATERIALS AND METHODSA total of 300 patients on active follow-up with Breast Service at Tan Tock Seng Hospital were interviewed using a structured questionnaire.

RESULTSA total of 35% (104 of 296) of patients reported using TCM. The majority of the patients were introduced to TCM by family and friends following the diagnosis of breast cancer. All except 3 patients continued with recommended conventional therapy although most did not inform their clinicians of TCM use. None of the patients reported any serious adverse events and 75% of them perceived a benefit from TCM use. Younger patients and those of Chinese ethnicity were more likely to use TCM (P <0.01 and P = 0.03 respectively). There was no significant difference in the dialect group, religious beliefs and educational level between the 2 groups (P >0.05).

CONCLUSIONTCM use is common among our breast cancer patients, particularly the younger women. However, most patients do not inform their clinicians of TCM use while on recommended conventional therapies. It is therefore important for clinicians to initiate discussions regarding TCM use in order to be aware of potential unwanted drug interactions.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; therapy ; Female ; Humans ; Medical Oncology ; Medicine, Chinese Traditional ; utilization ; Middle Aged