INTRODUCTION: Glaucoma is a leading cause of permanent blindness, often going undetected in its early, asymptomatic stages, especially in older age groups. In Malaysia, glaucoma is a growing public health issue due to an increase in the ageing population. While screening is essential for early glaucoma detection, the most suitable strategy for Malaysia's healthcare system remains unclear. This study explored the perspectives of eye healthcare professionals on the most suitable glaucoma screening strategies for Malaysia. MATERIAL AND METHODS: This qualitative study used semi-structured interviews with 19 eye health professionals (ophthalmologists, optometrists, nurses, ophthalmic technicians, and assistant medical officers) practicing in the Klang Valley. The interviews were conducted face-to-face in their workplace or via a video conferencing platform. All interviews were recorded, transcribed, and analysed using thematic analysis. RESULTS: Six major themes were identified: types of glaucoma screening programmes, accessible screening locations, target screening population, instruments and use of digital technology, trained personnel, and referral criteria. Opportunistic case finding and population-based programmes were identified as the glaucoma screening programmes in which trained personnel conducted screening at accessible locations. Glaucoma screening for high-risk individuals was recommended, focusing on visual acuity testing, tonometry, anterior chamber angle assessment, funduscopy, perimetry, and retinal nerve fibre assessment. A lack of clear referral criteria due to low awareness and poor implementation of existing guidelines was observed. CONCLUSION: Further investigations are required to identify the best combination of components for glaucoma screening. This will enable policymakers to develop an effective glaucoma screening programme in Malaysia.

Epigallocatechin-3-gallate (EGCG), a bioactive polyphenol abundant in green tea, has garnered significant attention for its diverse therapeutic applications, ranging from antioxidant and anti-inflammatory effects to potential anticancer properties. Despite its immense promise, the practical utilization of EGCG in therapeutic settings as a medication has been hampered by inherent limitations of this drug, including poor bioavailability, instability, and rapid degradation. This review comprehensively explores the current challenges associated with the application of EGCG and evaluates the potential of nanoparticle-based formulations in addressing these limitations. Nanoparticles, with their unique physicochemical properties, offer a platform for the enhanced stability, bioavailability, and targeted delivery of EGCG. Various nanoparticle strategies, including polymeric nanoparticle, micelle, lipid-based nanocarrier, metal nanoparticle, and silica nanoparticle, are currently employed to enhance EGCG stability and pharmacological activity. This review concludes that the particle sizes of most of these formulated nanocarriers fall within 300 nm and their encapsulation efficiency ranges from 51% to 97%. Notably, the pharmacological activities of EGCG-loaded nanoparticles, such as antioxidative, anti-inflammatory, anticancer, and antimicrobial effects, are significantly enhanced compared to those of free EGCG. By critically analyzing the existing literature and highlighting recent advancements, this article provides valuable insights into the promising prospects of nanoparticle-mediated EGCG formulations, paving the way for the development of more effective and clinically viable therapeutic strategies.
Animals ; Humans ; Anti-Inflammatory Agents/administration & dosage* ; Antineoplastic Agents/administration & dosage* ; Antioxidants/administration & dosage* ; Biological Availability ; Catechin/analogs & derivatives* ; Micelles ; Particle Size ; Nanoparticle Drug Delivery System/chemistry*

Purpose: Intracavernosal injections are used to treat erectile dysfunction. Patient compliance with intracavernosal injections is required for success, though factors influencing compliance are unknown. This study aimed to identify factors that influence compliance with intracavernosal injections among men with erectile dysfunction. Materials and Methods: A retrospective analysis was conducted using men who were prescribed intracavernosal injections between 2017 and 2022 at an academic medical center in a cosmopolitan area. Custom Python code was used to capture the first and last prescription refill events, and the duration of intracavernosal injection use was calculated. Additional patient-related data, including demographics and comorbidities, were gathered through chart reviews. Cox Proportional Hazards Regression models were used to evaluate the effects of predictor variables on the duration of intracavernosal injection use. Results: A total of 4,072 patients were included in the analysis. The study revealed that age significantly predicted discontinuation of intracavernosal injection therapy, showing an elevated hazard ratio of 1.007 for each additional year of age (p<0.001). Men who preferred to speak Spanish as their primary language was a significant predictor of discontinuation of injection therapy, showing a hazard ratio of 1.163 compared to those who preferred English (p=0.004). Men with a history of prostate cancer treatment stayed on treatment for 80 days fewer on average than those without (p=0.002). Conclusions Older age, prior history of prostate cancer treatment, and men who preferred to speak Spanish were all identified as factors potentially associated with reduced continuation of intracavernosal injection therapy for erectile dysfunction. Understanding these factors can help healthcare providers in both patient selection and counseling when discussing treatment options for erectile dysfunction.

Purpose: Intracavernosal injections are used to treat erectile dysfunction. Patient compliance with intracavernosal injections is required for success, though factors influencing compliance are unknown. This study aimed to identify factors that influence compliance with intracavernosal injections among men with erectile dysfunction. Materials and Methods: A retrospective analysis was conducted using men who were prescribed intracavernosal injections between 2017 and 2022 at an academic medical center in a cosmopolitan area. Custom Python code was used to capture the first and last prescription refill events, and the duration of intracavernosal injection use was calculated. Additional patient-related data, including demographics and comorbidities, were gathered through chart reviews. Cox Proportional Hazards Regression models were used to evaluate the effects of predictor variables on the duration of intracavernosal injection use. Results: A total of 4,072 patients were included in the analysis. The study revealed that age significantly predicted discontinuation of intracavernosal injection therapy, showing an elevated hazard ratio of 1.007 for each additional year of age (p<0.001). Men who preferred to speak Spanish as their primary language was a significant predictor of discontinuation of injection therapy, showing a hazard ratio of 1.163 compared to those who preferred English (p=0.004). Men with a history of prostate cancer treatment stayed on treatment for 80 days fewer on average than those without (p=0.002). Conclusions Older age, prior history of prostate cancer treatment, and men who preferred to speak Spanish were all identified as factors potentially associated with reduced continuation of intracavernosal injection therapy for erectile dysfunction. Understanding these factors can help healthcare providers in both patient selection and counseling when discussing treatment options for erectile dysfunction.

Purpose: Intracavernosal injections are used to treat erectile dysfunction. Patient compliance with intracavernosal injections is required for success, though factors influencing compliance are unknown. This study aimed to identify factors that influence compliance with intracavernosal injections among men with erectile dysfunction. Materials and Methods: A retrospective analysis was conducted using men who were prescribed intracavernosal injections between 2017 and 2022 at an academic medical center in a cosmopolitan area. Custom Python code was used to capture the first and last prescription refill events, and the duration of intracavernosal injection use was calculated. Additional patient-related data, including demographics and comorbidities, were gathered through chart reviews. Cox Proportional Hazards Regression models were used to evaluate the effects of predictor variables on the duration of intracavernosal injection use. Results: A total of 4,072 patients were included in the analysis. The study revealed that age significantly predicted discontinuation of intracavernosal injection therapy, showing an elevated hazard ratio of 1.007 for each additional year of age (p<0.001). Men who preferred to speak Spanish as their primary language was a significant predictor of discontinuation of injection therapy, showing a hazard ratio of 1.163 compared to those who preferred English (p=0.004). Men with a history of prostate cancer treatment stayed on treatment for 80 days fewer on average than those without (p=0.002). Conclusions Older age, prior history of prostate cancer treatment, and men who preferred to speak Spanish were all identified as factors potentially associated with reduced continuation of intracavernosal injection therapy for erectile dysfunction. Understanding these factors can help healthcare providers in both patient selection and counseling when discussing treatment options for erectile dysfunction.

Purpose: Fractures of the posterior column and posterior wall acetabulum are the most common pelvic fractures. In this study, we aimed to test the design of a new acetabular plate that combines the spring plate’s function and the plate’s reconstruction. This design should ease fixation and reduce surgery time, but is biomechanically untested. We analyzed this plate using finite element analysis (FEA). Materials and Methods: This observational study compares seven pelvic models: normal pelvis, posterior wall acetabular fracture, posterior column fracture, these two fractures combined, and the three fracture models fixed with the new acetabular plate. The evaluation was based on the analysis of deformation and stress distribution in each pelvic model under a force of 1,000 N directed at 45° from the sagittal and coronal planes. Results: In the normal pelvis, the greatest deformity was found on the ischial tuberosity (up to 3.91 mm and stress distribution tend to be homogenous. The new acetabular plate normalized the deformity and stress distribution to resemble the normal pelvis with highest stress on the ischial tuberosity and inferior side of the acetabulum. The largest deformation was in the middle of the plate and in the screw. Conclusion The novel plate can normalize stress and deformity in a fractured pelvis and may provide a solution for combining the posterior column and posterior wall of the acetabulum.

Purpose: This study aimed to develop a graded prognostic assessment (GPA) model integrating genomic characteristics for elderly patients with glioblastoma (eGBM), and to compare the efficacy of different radiotherapy schedules. Materials and Methods: This multi-institutional retrospective study included patients aged ≥ 65 years who underwent surgical resection followed by radiotherapy with or without temozolomide (TMZ) for newly diagnosed eGBM. Based on the significant factors identified in the multivariate analysis for overall survival (OS), the molecular GPA for eGBM (eGBM-molGPA) was established. Results: A total of 334 and 239 patients who underwent conventionally fractionated radiotherapy (CFRT) and hypofractionated radiotherapy (HFRT) were included, respectively, with 86% of patients receiving TMZ-based chemoradiation. With a median follow-up of 17.4 months (range, 3.3 to 149.9 months), the median OS was 18.7 months for CFRT+TMZ group, 15.1 months for HFRT+TMZ group, and 10.4 months for radiotherapy alone group (CFRT+TMZ vs. HFRT+TMZ: hazard ratio [HR], 1.52; p < 0.001 and CFRT+TMZ vs. radiotherapy alone: HR, 2.52; p < 0.001). In a combined analysis with the NOA-08 and Nordic trials, CFRT+TMZ group exhibited the highest survival rates among all treatment groups. The eGBM-molGPA, which integrated four clinical and three molecular parameters, stratified patients into low-, intermediate-, and high-risk groups. CFRT+TMZ significantly improved OS compared to HFRT+TMZ or radiotherapy alone in the low-risk (p=0.023) and intermediate-risk groups (p < 0.001). However, in the high-risk group, there was no significant difference in OS between treatment options (p=0.770). Conclusion CFRT+TMZ may be more effective than HFRT+TMZ or radiotherapy alone for selected eGBM patients. The novel eGBM-molGPA model can guide treatment selection for this patient population.

Epigallocatechin-3-gallate (EGCG), a prominent plant-based catechin predominantly derived from Camellia sinensis and widely available on the market as a health supplement, has garnered significant attention for its potential therapeutic benefits, particularly in the context of type 2 diabetes mellitus (T2DM). This review explores the multifaceted role of EGCG in addressing the "ominous octet"-the 8 core pathophysiological defects associated with T2DM. The literature search was carried out using key terms "EGCG" OR "epigallocatechin-3-gallate" OR "epigallocatechin gallate" AND "diabetes" OR "insulin resistance" OR "hyperglycemia" in the PubMed and Scopus databases. The search was constrained to articles published between January 2018 and April 2024, focusing on the document type. Full-text articles published in English and relevant to EGCG that featured a single active ingredient, included clearly explained diabetes relief mechanism, and included ominous octet aspects were included in the final review. The outcomes of the included studies were reviewed and categorized based on 8 core pathophysiological defects, collectively referred to as the ominous octet in T2DM. This review concludes that EGCG is a potent hypoglycemic agent that has beneficial effects against the ominous octet in addition to its pharmacological activities in modulating gut microbiota dysbiosis, carbohydrate digestion and metabolism, glucose transporter-mediated intestinal glucose-uptake, endothelial dysfunction, and renal damage that are significantly associated with pathogenesis of T2DM. This extensive scientific evidence suggests that EGCG may offer a novel approach to traditional antidiabetic therapies, potentially improving glycemic control and mitigating complications associated with T2DM. The inhibitory effects of EGCG on sodium-glucose transport proteins and their role in reducing renal glucose reabsorption remain unexplored, highlighting a significant research gap. Future research should also aim to broaden the scope by investigating the "egregious eleven," which comprise a more comprehensive range of diabetic pathophysiological features. This review underscores the therapeutic promise of EGCG for managing T2DM and encourages ongoing research to fully elucidate its clinical applications. Please cite this article as: Wong CN, Lim YM, Liew KB, Chew YL, Chua AL, Lee SK. A review on mechanistic actions of epigallocatechin-3-gallate in targeting the ominous octet of type 2 diabetes mellitus. J Integr Med. 2025; 23(4): 344-356.
Diabetes Mellitus, Type 2/physiopathology* ; Humans ; Catechin/therapeutic use* ; Hypoglycemic Agents/therapeutic use* ; Animals ; Insulin Resistance

OBJECTIVE

Previous studies have indicated that clinical hypogonadism is common among males with type 2 diabetes mellitus (T2DM). However, the reported prevalence varies due to the diverse diagnostic criteria used in these studies. This study aims to determine the prevalence of clinical hypogonadism among Malaysian T2DM males and their associated factors.

A total of 360 participants who fulfilled the inclusion criteria were included in this study. Their socio-demographic and clinical parameters were documented and a total testosterone level was sampled from a morning fasting serum. Patients with serum total testosterone of 8-12 nmol/L had their serum total testosterone repeated and their symptoms assessed with the Aging Male Symptoms (AMS) scale. Clinical hypogonadism was diagnosed with total testosterone 26.

The prevalence of clinical hypogonadism among Malaysian T2DM males was 17.5% (n = 63), with 55.6% of them having hypogonadotropic hypogonadism. There is a significant association between clinical hypogonadism with waist circumference > 94 cm (p < 0.001), obesity (p < 0.001), hypertension (p = 0.010), coronary artery disease (p = 0.014) and peripheral artery disease (p = 0.022). There is a significant difference in the weight (p = 0.001), BMI (p < 0.001), waist circumference P < 0.001), serum HDL-C levels (p < 0.001), serum triglycerides levels (p = 0.001) and serum TyG index (p < 0.001). Diabetic males with increasing age (adjusted OR = 1.070, 95% CI 1.004-1.146, p = 0.038), presence of coronary artery diseases (adjusted OR = 2.08, 95% CI 1.220-10.219, p = 0.020) and low total testosterone (adjusted OR = 2.451, 95% CI 1.908-3.155, p < 0.001) are at higher risk of developing clinical hypogonadism.

This study is the first in the Asian region to use stricter criteria for diagnosing hypogonadism. Despite these stringent criteria, the prevalence of hypogonadism remains significantly high among Malaysian T2DM males. It is particularly common in diabetic males over 35 years old with coronary artery disease, regardless of A1c control and the duration of diabetes.

This study investigated the current status of depressive symptoms among Chinese college students and analyzed the association between being an only child and depressive symptoms. A cross-sectional survey was conducted with 771 college students from five universities in Jilin Province. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). The results indicated that 28.4% of college students exhibited depressive symptoms. Only children reported significantly higher depressive symptom scores compared to non-only children, and female students had higher scores than their male counterparts. These findings highlight the importance of targeted mental health interventions for only children.