Introduction: Improving glycemic control while minimizing unnecessary insulin exposure is an important goal in diabetes management. The Rapid Optimization Clinic (ROC) was established as a structured multidisciplinary service to support therapy individualization, close follow-up, and timely insulin deintensification. This audit evaluated early changes in glycated hemoglobin A1c (HbA1c) and insulin treatment burden following ROC care over 3 months. Methodology: We conducted a retrospective audit of routine clinical data from patients with diabetes managed in the ROC at a district hospital. Baseline and 3-month HbA1c and insulin data were extracted from non-electronic clinic records. Insulin dose was standardized as total daily dose (TDD) in units/kg/day. Insulin deintensification was evaluated primarily by change in TDD from baseline to 3 months and by the proportion of patients who discontinued insulin during follow-up. Paired analyses were performed for patients with complete baseline and follow-up data for each outcome. Continuous variables are presented as mean ± standard deviation or median with interquartile range, as appropriate. Exploratory analyses were undertaken to assess whether available patient factors were associated with HbA1c improvement. Results: Twenty-three patients were included. Paired HbA1c data were available for 12 patients, whereas paired TDD data were available for 21 patients. Mean HbA1c decreased from 10.78 ± 2.59% at baseline to 8.42 ± 2.29% at 3 months, representing a mean reduction of 2.36 percentage points (95% confidence interval [CI] 0.09–4.62; p = 0.043). Mean TDD decreased from 0.434 ± 0.248 to 0.286 ± 0.313 units/kg/day, corresponding to a mean reduction of 0.148 units/kg/day (95% CI 0.077–0.219; p <0.001). Insulin was discontinued in 9 of 21 patients (42.9%). No clear association was observed between HbA1c improvement and age, sex, or number of visits. Interpretation is limited by the small sample size, reflecting the early phase of a newly established clinic. Conclusion In this early audit, ROC care was associated with clinically meaningful improvement in glycemic control and significant insulin deintensification over 3 months. These findings support the potential role of a structured multidisciplinary optimization clinic in delivering individualized diabetes care and facilitating safe reduction of insulin burden.
Humans ; Glycemic Control ; Retrospective Studies ; Diabetes Mellitus ; Insulins

Introduction: Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal chromaffin cells, with an estimated incidence of 2–8 cases per million per year. These tumors originate from neural crest–derived cells of the sympathetic and parasympathetic paraganglia and may secrete catecholamines, resulting in malignant hypertension or symptoms such as headache, palpitations, and diaphoresis. They can occur anywhere along the paravertebral and para-aortic regions from the skull base to the pelvic floor. Case: We report a case of a 14-year-old male with no known premorbid conditions who presented with presyncope and a 1-month history of headache. On examination, he had severe hypertension (242/167 mmHg), tachycardia (127 bpm), and grade IV hypertensive retinopathy. Investigations showed preserved renal function with markedly elevated 24-hour urinary metanephrines (normetanephrine 90.75 µmol/L). Computed tomography revealed a lobulated, heterogeneously enhancing mass measuring 5.0 × 6.1 × 5.4 cm along the left margin of the abdominal aorta at the infrarenal level, suggestive of an extra-adrenal lesion. Gallium-68 PET scan demonstrated a somatostatin receptor–avid left peritoneal mass. The patient underwent exploratory laparotomy and tumor excision, complicated intraoperatively by blood pressure lability requiring nitroprusside and inotropic support. Postoperatively, he improved significantly and was able to wean off all antihypertensive medications. Histopathology confirmed left retroperitoneal paraganglioma. Conclusion Primary peritoneal paraganglioma is a rare but important cause of secondary hypertension, especially in young patients presenting with hypertensive emergency. High index of suspicion is essential for early diagnosis. Management requires a multidisciplinary approach with careful preoperative optimization to minimize perioperative complications. Surgical resection remains the definitive treatment and, as demonstrated in this case, can result in marked clinical improvement with resolution of hypertension.
Paraganglioma

This paper provides a comprehensive review of the antibacterial properties of three different types of Malaysian honey, namely kelulut, tualang and acacia, in preventing wound infecting bacteria. The antibacterial activity of these honey is mainly attributed to the physicochemical and phytochemical, which have been shown to be effective against a broad range of bacterial pathogens. This review discusses the effectiveness of honey in inhibiting the growth of various wound-infecting bacteria, factors that contributed to the antibacterial properties of the honey, mechanisms of action of honey in inhibiting bacterial growth and their potential for future use in clinical practice. The findings of this review suggest that Malaysian honey has the potential to be used as an alternative and complementary therapy to conventional antibiotics in the prevention and treatment of wound infections.

PEER-ASSISTED LEARNING APPROACH IN DENTAL CURRICULUM: THE IMPACT ON STUDENTS’ ACADEMIC PERFORMANCES Peer-assisted learning (PAL) is a peer tutoring strategy that can benefit dental education, such as enhanced experience and comprehension. The objective of the study is to assess the impact of PAL on student learning and the development of clinical skills and to evaluate the students' perceptions of this learning approach. A quasi-experimental study and online cross-sectional study were conducted from March 2022 to March 2023 to assess three main focuses, which are students' clinical competencies, students' perception towards PAL, and academic performances. This quasi-experimental study involved 82 fourth-year dental students divided into two groups to observe either orthodontic impression-taking (group A) or facebow transfer (group B) procedures for six months, followed by assessments of their clinical competencies of both procedures. Pre-seminar and post-seminar tests were done to evaluate the academic performance of fourth-year dental students. A validated questionnaire was used to assess the perceptions of 190 students from year 3 to year 5. There was no significant difference in clinical performance between groups following PAL sessions. There were weak correlations between groups A (p=0.538) and B (p=0.279), indicating a weak relationship between PAL and students’ clinical competencies. However, PAL helps to improve theoretical knowledge, which showed an increase in average scores in the pre-test and post-test. Moreover, the questionnaire responses reported positive perceptions of the PAL approach. The study found no significant correlation between PAL and students’ clinical performances. However, student feedback showed this approach to be beneficial in enhancing the clinical exposure of dental students and should be implemented in dental schools.

Introduction: Anacardium occidentale or cashew are popular traditional food and have raised research interest for complementary cancer treatment. Cancer has become leading cause of death and treatment involved severe side effects. In present study, we aim to study the anti-proliferative effects of cashew shoots in breast cancer (MDAMB-231), colorectal cancer (HT-29) and liver cancer (HepG2) cell lines. Methods: Cell lines were treated with 70% ethanolic cashew extract for cytotoxicity test with MTT assay. AO/PI dual fluorescent assay and RNase/PI staining were used to determine apoptosis induction effects. Phytochemicals screening was carried out by using gas chromatography mass spectrometry (GCMS) and liquid chromatography mass spectrometry (LCMS). Results: The cytotoxicity assay of cashew shoot extract demonstrated IC50 of 81.1 ± 0.11 μg/ml for MDA-MB-231, 307.5 ± 2.31 μg/ml for HT-29 and 272.6 ± 1.91 μg/ml for HepG2 cell lines. The apoptotic bodies include chromatin condensation, cell blebbing and nuclear fragmentation and apoptosis induction were shown by AO/PI staining. There was significant increase of cell count in sub-G0 phase in MDA-MB-231 cell lines treated with cashew shoot extract. It was demonstrated that cashew shoot extract contained 38 compounds from GCMS such as sitosterol, tannin, pyrogallol, phenol and 20 compounds from LCMS such as citric acid, gallic acid, myricetin and hinokiflavone that may give rise to its anti-cancer effect. Conclusion: Cashew shoot extract demonstrated potential anti-cancer properties thus further study is required to investigate its mechanism as anti-cancer agent.

Objective: Malaysia’s first case of coronavirus disease (COVID-19) was reported in January 2020, with the first case in the state of Negeri Sembilan diagnosed on 17 February 2020. The National COVID-19 Immunisation Programme commenced in early March 2021 in Negeri Sembilan. This study describes the COVID-19 cases and vaccination coverage in Seremban District, Negeri Sembilan, during 2021. Methods: The demographic and clinical characteristics of COVID-19 cases and the district’s vaccination coverage were described. Vaccination coverage was plotted against COVID-19 cases on the epidemic curve. The chi-square test was used to examine the differences between the vaccination status of COVID-19 cases and severity category, hospitalization status and mortality. Results: In Seremban District, there were 65 879 confirmed cases of COVID-19 in 2021. The data revealed that the 21–30-year age group had the highest proportion of cases (16 365; 24.8%), the majority of cases were male (58.3%), and most cases were from the sub-district of Ampangan (23.1%). The majority of cases were Malaysian. Over half (53.5%) were symptomatic, with fever (29.8%) and cough (22.8%) being the most frequently reported symptoms. COVID-19 vaccination status was significantly associated with severity category, hospitalization and mortality (P < 0.001 for all categories). Discussion: This is the first study to describe two-dose vaccination coverage and the trend in COVID-19 cases in Seremban District. It was observed that COVID-19 cases had been reduced following more than 60.0% vaccination coverage.

Aims: In this study, three putative factors that commonly contribute to antibacterial properties in honey were determined, namely acidity (pH level), peroxide compounds and non-peroxide compounds. Methodology and results: Honey samples were prepared based on the known factors of acidity, peroxide compounds,and non-peroxide compounds to identify factors that contribute to the antibacterial properties of the honey based on agar diffusion assay. Liquid chromatography quadropole time-of-flight mass spectrometry was employed to detect and quantify the presence of acidic, peroxide, and non-peroxide compounds in the honey samples. Acidity and non-peroxide compounds were identified as the significant factors contributing to the antibacterial properties of Kelulut, Tualang and Acacia honey. No peroxide compound was detected in this study across all honey samples. In Kelulut, the presence of the additional compounds (reptoside, platycogenic acid and kauranoic acid) may explain its higher antibacterial properties against Escherichia coli and Staphylococcus aureus as compared to Tualang and Acacia honey based on the inhibition zones on the agar plates. Conclusion, significance and impact of study The presence of multiple antibacterial factors in honey is notably important as it gives an advantage of using honey compared to antibiotics in preventing the growth of a wide range of bacterial species with multiple modes of action.

Objective: Foodborne disease is a significant global public health concern, with Bacillus cereus being a frequent cause of outbreaks. However, due to the relatively mild symptoms caused by infection with B. cereus, the shorter duration of illness and the challenges of testing for it in both stool and food samples, outbreaks are often underreported. This report describes the epidemiology of cases of foodborne illness, the causative agent and risk factors associated with an outbreak in a boarding school in Seremban district, Negeri Sembilan state, Malaysia, that occurred in November 2021. Methods: Epidemiological, environmental and laboratory investigations were performed. A case was defined as any person with abdominal pain, vomiting or diarrhoea that occurred after consuming food served by the canteen at the school. The data were analysed using Microsoft Excel and the Statistical Package for the Social Sciences (SPSS). Results: A total of 152 cases were identified among the 597 students, giving an attack rate of 25.5%. All cases were females aged 13–17 years. They presented with abdominal pain (100%), nausea (97.4%, 148), vomiting (78.3%, 119) or diarrhoea (61.8%, 94), or a combination of these. The mode of transmission of the outbreak was a continual common source. The foods associated with becoming a case were beef rendang (a dry curry) (odds ratio [OR]: 20.54, 95% CI: 4.89–86.30), rice (OR: 19.62, 95% CI: 2.62–147.01), rice cubes (OR: 18.17, 95% CI: 4.31–76.55) and vermicelli (OR: 17.02, 95% CI: 4.03–71.86). Cross-contamination and inadequate thawing and storage temperatures contributed to the outbreak. Discussion: This outbreak of foodborne illness at a boarding school was likely caused by B. cereus. The findings highlight the importance of proper food preparation, temperature monitoring, hygiene practices among food handlers and compliance with food safety guidelines.

Introduction: To combat the COVID-19 pandemic, Malaysia started vaccination of front-liners and adults in the community. The latter group might have insufficient knowledge to accept COVID-19 vaccination, therefore this research was to assess the knowledge and acceptance of COVID-19 vaccination among youths, specifically students in a Malaysian college. Methods: A cross-sectional study was conducted among 481 foundation students in Kolej MARA Kulim (KMKU). The minimum sample size, using Epi Info was 214. Students answered an online questionnaire using google form which included demographic data (age, gender) and ten questions on knowledge and acceptance of COVID-19 vaccination. For knowledge questions, students answered “yes”, “no” or “don’t know”, correct answer scoring 1. For acceptance questions, a 5-point Likert scale was used ranging from “strongly disagree” to “strongly agree”. EXCEL and SPSS version 23 were used for analysis with Chi-square test done to test association (significant for p-value <0.05). Results: The response rate was 65.1% with 313 students, (45.4% males, and 54.6% females) aged 18-19 years. The majority (83.7%) had satisfactory to excellent knowledge scores (mean = 6.66 (SD=2.299, 95% CI 6.40-6.91), median = 7 (± IQR =3), while 16.3% obtained poor scores (≤ 4). The majority (90%) accepted vaccination. Higher knowledge scores were associated with higher acceptance rates in both genders (p-value= 0.000). Significantly more females (90.6%) than males (80.3%) had positive attitude towards vaccination (p-value = 0.009). Conclusions: The majority of the foundation students in KMKU were knowledgeable on COVID-19 vaccination and willing to receive the vaccination against the novel coronavirus.

This study focused, for the first time, on the effect of ultrasonic features on the extraction efficiency of secondary metabolites in mustard seed cake (MSC). The nematostatic potential of sonicated seed cake was examined against the second-stage juveniles (J2s) of root-knot nematode,