CYTOTOXICITY AND CHARACTERISATION OF POLYMETHYL METHACRYLATE DENTURE BASE ENHANCED WITH LINSEED OIL (PMMA-L) Objectives: Polymethyl methacrylate (PMMA) is a widely used polymer for a denture base material. Dibutyl phthalate was previously utilised as a synthetic plasticiser in PMMA, but concerns about ester leaching have raised awareness of using organic plasticisers, such as linseed oil. The objective of this research was to assess the cytotoxic effects of linseed oil and to characterise the experimental polymethyl methacrylate enhanced with linseed oil (PMMA-L). Method: The cytotoxicity of linseed oil (LO) was evaluated by exposing Human Gingival Fibroblast (HGF) cells to different linseed oil concentrations (1%, 3%, 5%, 7%, and 10%) for 24, 48, and 72 hours. Afterwards, cell viability was measured with the WST-1 assay, and a spectrophotometer was used for cell quantification. Five groups of PMMA-L were prepared, each containing different percentages of linseed oil (1%, 3%, 5%, 7%, and 10% by weight). These samples underwent an ageing process involving 5,000 cycles of thermocycling between 5°C and 55°C with a 30-second dwell time. Compositional and leaching analyses of PMMA-L were performed using attenuated total reflection fourier-transform infrared spectroscopy (ATR-FTIR). Results: The results from the WST-1 assay consistently showed cell viability exceeding 95% across all doses and incubation periods, indicating the non-cytotoxicity of LO. Composition analysis revealed that the ATR-FTIR spectra of PMMA-L and linseed oil were identical within the C=C stretching vibration range (1536-1652 cm-1), originating from unsaturated triglyceride compounds found in linseed oil but not in PMMA. Additionally, the leaching analysis did not detect any leaching of linseed oil from PMMA-L. Conclusions: The research offers proof of the non-cytotoxic nature of linseed oil. Moreover, the successful creation of PMMA-L is evident, as indicated by the incorporation of the linseed oil component in PMMA-L and the absence of linseed oil in the leaching analysis.

ASSOCIATION BETWEEN MEDICATION ADHERENCE AND BLOOD PRESSURE CONTROL AND FACTORS ASSOCIATED WITH ANTIHYPERTENSIVE MEDICATION ADHERENCE IN THE MELAKA TENGAH DISTRICT: A CROSS-SECTIONAL SURVEY Introduction: The burden of cardiovascular disease and early morbidity and mortality is exacerbated by hypertension. According to the 2019 National Health and Morbidity Survey, 30% of adults in Malaysia aged over 18 years had hypertension. Our study aimed to investigate the association between medication adherence and blood pressure control and the factors associated with antihypertensive medication adherence. Methods: This cross-sectional study was conducted among adult patients with hypertension who had been under treatment at public primary health clinics in the Melaka Tengah District. A self-administered questionnaire was used, and blood pressure was measured. Descriptive and multivariate logistic regression analyses were conducted using the Statistical Package for the Social Sciences (version 28). Results: A total of 1531 patients were recruited in this study. Among them, 74.1% had good antihypertensive medication adherence, and 51.4% had their blood pressure controlled. Medication adherence was significantly associated with blood pressure control (P<0.005). The multivariate analysis showed that the determinants for antihypertensive medication non-adherence were Malay ethnicity, secondary education, farther distance from the clinic, experience of side effects of antihypertensive medications, concern about long-term side effects and usage of alternative medicine (P<0.05). Taking multiple antihypertensive medications was the only factor associated with uncontrolled blood pressure (P<0.05). Conclusion: Addressing issues on medication adherence is important to ensure blood pressure control. The factors associated with non-adherence should be closely monitored to improve blood pressure control and prevent adverse health outcomes. Single-pill combination antihypertensive medications are encouraged to reduce pill burden and improve blood pressure control.

Introduction: Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU). Materials and method: This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and Creactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification. Results: The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL. Conclusion: PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.

Introduction: Urinary citrate is a potent inhibitor of urinary crystallization that is freely filtered in the proximal tubule of the kidney. We aimed to investigate the effect of citrate supplementation with fresh lime juice on the urinary pH and calcium excretion level among healthy individuals compared with that of mist potassium citrate. Methods: In this prospective, cross-over single-centre study, 50 healthy medical student volunteers were randomly allocated to two treatment arms. One arm was prescribed with potassium citrate, while the other arm received citrate supplementation with a home preparation of fresh lime juice. The urinary pH and calcium-to-creatinine ratio (uCa/uCr) were measured at baseline and after 7 days of treatment. This was followed by a washout period of 2 weeks, after which each participant crossed over to the other treatment arm, and the urinary measurements were repeated. Results: Potassium citrate significantly increased the urinary pH among all participants, while fresh lime juice did not. Both fresh lime juice and potassium citrate reduced the uCa/uCr, although this effect was not significant. Conclusion Fresh lime juice is not as effective as potassium citrate in improving the urinary pH and calcium excretion level of healthy individuals. Therefore, it should be used as an adjunct rather than an alternative to potassium citrate.
Potassium Citrate ; Urolithiasis

ABSTRACT Granulomatosis with polyangiitis (GPA) is a rare multisystem disease. Although GPA is rare, it commonly presents in a localised stage where its manifestation involves the upper or lower respiratory tract before progressing to a generalised stage. Therefore, most patients with GPA will visit an oral surgeon or an otolaryngologist to seek treatment. However, the diagnosis of GPA is often delayed as GPA is not frequently considered as a differential diagnosis in common oral and facial diseases. The lack of gold standard investigation for the diagnosis of GPA makes management of this case, a diagnostic conundrum. We herein report a patient who was diagnosed with bilateral acute otitis media and left mastoiditis complicated with facial nerve palsy, and later developed tongue ulceration one month after his initial presentation. The ear, facial and oral symptoms represent a diagnostic red herring to a full-blown generalised stage of GPA.
Facial Paralysis ; Oral Ulcer ; Granulomatosis with Polyangiitis

The Coronavirus disease (COVID-19) imparted unprecedented negative impact worldwide since it was declared as a global pandemic in 2020 due to its high infectivity and mortality rate. Consequently, those who have been infected with COVID-19 experienced significant amount of social stigma which resulting in deterioration of mental well being. Hence, this study aimed to translate the Explanatory Model Interview Catalogue Stigma Scale (EMIC-SS) into Malay and investigate the reliability and validity of the Malay version (EMIC-SS-M) among COVID-19 survivors in Malaysia. Initially, concurrent translation and back translation of the EMIC-SS was conducted followed by the assessment of its face and content validity. Then, the EMIC-SS-M was administered to 219 COVID-19 survivors recruited from three targeted centers for assessment of its reliability (internal consistency) and validity (convergent and discriminant validity, exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]). The EMIC-SS-M reported an acceptable internal consistency with Cronbach’s α of 0.727, while its domains reported acceptable Cronbach’s α ranged from 0.708 to 0.795. EFA and CFA confirmed that the EMIC-SS-M consisted of 15 items in 4 domains. The EMIC-SS-M exhibited good psychometric properties and ready for use to assess stigma among COVID 19 survivors in Malaysia. It can be adapted for use to assess stigma in other disease conditions among the Malaysian population in future studies.
COVID-19

Introduction: Distal radial fracture is a commonly encountered fracture. This study aims to study the epidemiology of distal radial fracture and factors affecting the patients’ functional outcome one to two years after the injury. Materials and methods: This is a retrospective cohort study. The records of patients, fulfilling the radiographical diagnosis of distal radial fracture, and aged 18 and above, who presented to our Emergency Department from 1st January 2018 to 31st December 2018 were retrieved. According to AO classification, we grouped our patients into A (extra-articular), B (partial articular) and C (complete articular). Patients with congenital abnormalities were excluded. Epidemiological data and relevant medical history were obtained and tabulated. A Malaysian language translation of Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to assess the functional outcome. Results: Out of 168 patients’ data retrieved, only 110 patients’ data were found complete for purposes of this study. The mean DASH score was 13.7 ± 7.87 approximately one to two years post-injury regardless of treatment method. Increasing age was associated with higher DASH score with r=0.407(p<0.001). Several variables had significantly better functional outcome: male gender (p=0.01), Type A fracture configuration (p=0.007) and non-operational treatment (p=0.03). There was no significant difference between treatment modalities in Type A fracture (p=0.094), but Type B (p=0.043) and Type C (p=0.007) had better outcome without surgery. There was no significant difference between different ethnic groups, open or closed fracture and mechanism of injury. Conclusion: Better functional outcome after sustaining distal radial fracture was associated with young age, male gender, type A fracture and treated non-operatively. Interestingly, more complex fracture pattern had better functionality were observed without surgery.

The incidence of neurenteric cyst (NC) is rare amongst spine tumors. It is most often asymptomatic but may present with sensory and motor symptoms. When associated with thoracic vertebra fusion it is not reported before, this complicates the placement of pedicle screw during posterior instrumentation. Herein, we report a case of thoracic spinal neurenteric cyst in a 40-year-old man that presents with chronic back pain, left lower limb weakness and numbness. Elective excision of NC over T6-T7 with laminectomy and multilevel posterior instrumentation was successfully performed with significant improvement of the symptoms. Neurenteric cyst is a rare spinal cord lesion which may cause permanent neurological sequalae. Complete surgical excision with spine fixation in this case provides good long-term outcome.

Objective: To determine the etiologies of tropical acute febrile illness (TAFI) in West Pahang, Malaysia and to investigate morbidity and mortality factors in relation to TAFI. Methods: A multicenter prospective cohort study was conducted between January and June 2016 in six district hospitals throughout the western part of Pahang State in Peninsular Malaysia. A total of 336 patients answered a standardized questionnaire and blood samples were collected for laboratory confirmation of infectious etiology. Descriptive analysis and logistic regression were performed to identify factors associated with TAFI. Results: A total of 336 patients were included. The patients were mainly Malays (70.2%), males (61.3%), aged (44.6±17.4) years, with more than half (58.9%) presenting with gastrointestinal symptoms. The majority were diagnosed with dengue (35.7%) while malaria (4.5%) was the least frequent. The in-hospital mortality due to TAFI was 9.2%. Patients with meliodosis had five times higher mortality [Adjusted OR: 5.002, 95% CI: (1.233, 20.286)]. Patients with comorbidities such as cardiovascular symptoms (P <0.001) and renal replacement therapy initiation (P <0.001) were significantly associated with in-hospital mortality in all TAFI. Conclusions: The etiology of TAFI in the western Pahang includes dengue, leptospirosis, malaria and melioidosis, which carry the highest risk of in-hospital mortality. The presence of cardiovascular symptoms may be used to assess the disease severity in TAFI, but more studies are needed in the future.

Hope leads to lower depression and anxiety and is associated with improved quality of life of cancer patients. In thisstudy, Hope Scale (HS) was translated into Malay, and the psychometric properties of the Malay version of the HopeScale were investigated among Malaysian cancer patients. Concurrent translation and back translation of the originalEnglish version of the Hope Scale were performed, and the Malay version was administered to 195 cancer patientswith different cancer diagnoses at baseline assessment and 2 months later at follow-up. The Hope Scale (Malay) totalscore (Cronbach’s α = 0.72; intraclass correlation coefficient (ICC) = 0.67) and its domains (Cronbach’s α [pathway] =0.7; Cronbach’s α [agency] = 0.7; ICC[Pathway] = 0.64; ICC[Agency] = 0.70) demonstrated acceptable internal consistencies andtest-retest reliability. Convergent and discriminant validities were also achieved by the Hope Scale (Malay). The HopeScale (Malay) demonstrated construct validity, as confirmatory factor analysis demonstrated that the items in the HopeScale (Malay) best fit into two domains, which was true for the original English version. The Hope Scale (Malay) hadacceptable psychometric properties and thus is suitable for assessing hope in Malaysian cancer patients.