Introduction: Hypertension is common in obesity and increases cardiovascular risk. Bariatric surgery improves metabolic health, but subgroup differences in blood pressure response remain unclear. This study examined 1-year changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after bariatric surgery across sex, age group, and diabetes status. Methodology: This study included 32 obese adults undergoing bariatric surgery, with blood pressure measured at baseline, 6 and 12 months. Generalized estimating equation models were used to evaluate changes in SBP and DBP over time, adjusting for age, sex, surgery type, diabetes category, baseline body mass index, antihypertensive medication use, and baseline blood pressure. Interaction terms were tested to assess differences in blood pressure trajectories across subgroups. Results: Participants were predominantly female (67.4%), with a mean age of 36.9 ± 6.2 years and a mean body mass index of 40.7 ± 8.8 kg/m². Hypertension and diabetes were present in 40.6 and 31.3% of participants, respectively. There was a significant time effect for both SBP (p <0.001) and DBP (p = 0.004). At 12 months post-surgery, mean SBP decreased by 15 mmHg and DBP by 7.9 mmHg compared with baseline (both p <0.001). No significant interactions were observed between time and sex, diabetes category, or age category, indicating that blood pressure improvements were comparable across subgroups. Conclusion Bariatric surgery was associated with clinically meaningful reductions in both SBP and DBP, with similar improvement patterns observed across demographic and metabolic subgroups. These findings support the effectiveness of bariatric surgery as a strategy for blood pressure reduction and cardiovascular risk management in patients with obesity.
Blood Pressure ; Bariatric Surgery

Introduction: Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder that significantly affects adolescent girls, particularly those with overweight or obesity. However, data examining the determinants and metabolic profiles of PCOS among adolescents with overweight and obesity remain limited, especially in Malaysia. This protocol describes a case-control study investigating the cardiometabolic, dietary, and psychosocial determinants of PCOS among adolescents with overweight and obesity. Methodology: This study is designed as a case-control study involving adolescent girls aged 13–16 years with a body mass index z-score >+1 standard deviation. Cases are defined as adolescent girls with a confirmed diagnosis of PCOS based on the recommendations of the 2017 International Consortium of Paediatric Endocrinology (ICPE), while controls are those who do not meet the diagnostic criteria for PCOS. A total sample size of 440 participants is required. Participants will be recruited from 22 secondary schools selected from a list of schools in Kuala Lumpur. Data on sociodemographic characteristics, psychosocial health, physical activity, and dietary intake will be collected using structured questionnaires. Blood samples will be obtained and analyzed for diagnostic testing (free testosterone), exclusion tests (thyroid-stimulating hormone, folliclestimulating hormone, luteinizing hormone, estradiol, prolactin, and dehydroepiandrosterone sulfate), and biochemical parameters (liver function tests, lipid profile, hemoglobin A1c, fasting glucose, fasting insulin, and inflammatory markers). Results: The study is expected to generate comprehensive data on the cardiometabolic, dietary, and psychosocial determinants of PCOS among adolescents with overweight and obesity. The findings will inform early screening strategies and targeted interventions aimed at reducing long-term reproductive and cardiometabolic complications. Conclusion This protocol outlines a structured approach to investigating PCOS in adolescence and addresses current gaps in early identification and risk stratification among highrisk populations.
Adolescent ; Humans ; Case-Control Studies ; Overweight ; Polycystic Ovary Syndrome ; Obesity

Introduction: The nutritional status of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Down Syndrome (DS) is influenced by multiple food environment determinants. However, the precise relationship between food environment determinants and nutritional outcomes in these children remains unclear. This study aimed to understand the food environment determinants that are associated with the intake and nutritional status of these children in Malaysia, Lao PDR, and Indonesia. Methods: This cross-sectional study involved 7- to 18-year-old students with ADHD and DS in three Southeast Asian countries. Sociodemographic characteristics, dietary habits, and repeated 24-hour food recall data were collected through a structured questionnaire. Anthropometric data were obtained through direct measurements and analysed using the WHO AnthroPlus software. Further analyses were done using descriptive statistics and chi-square tests. Results: Total participants were 284 children, comprised of 37.7% with ADHD and 62.3% with DS; 62.3% of the children were boys and 37.7% were girls. Among the food environment determinants collected during the study, monthly household income and school food assistance status had significant associations (p<0.05) with BMI-for-age z-score category and total energy, protein, zinc, and calcium intakes. While the country, type of residence, and type of school had significant associations with total energy, protein, zinc, and calcium intakes. Conclusions: Food environment determinants, particularly household income and access to school food assistance, significantly influence the nutritional status and intake of children with ADHD and Down Syndrome. Thus, strengthening inclusive nutrition programmes may improve outcomes for this vulnerable group in Southeast Asia.

Aims: Calamus castaneus is a non-climbing rattan plant widely distributed in tropical rainforests. The sharp spines of rattan palm harbour endophytic fungi, which may produce extracellular enzymes that contribute to various functions without harming the host plant. This study was aimed to evaluate the ability of fungal endophytes isolated from the C. castaneus spines to produce extracellular enzymes, including protease, pectinase, amylase, lipase and cellulase. Methodology and results: Thirty-four (34) endophytic fungal isolates were tested for their ability to produce extracellular enzymes using the agar plate method. Enzyme activity was measured using the enzyme index (EI) by measuring the halo (clear zone) on the agar medium. The EI value indicates the strength of the enzyme produced by the endophytes. Results demonstrated that all thirty-four fungal endophytes could produce at least one extracellular enzyme. Xylaria cubensis BR90 showed the highest protease activity of 5.73 EI. Muyocopron laterale (SM60) showed the highest pectinase activity of 2.74 EI. For lipase and cellulase activities, Cyphellophora guyanensis (BR71) produced 2.26 EI while Acremonium hennebertii (BR70) produced 1.97 EI, respectively. Conclusion, significance and impact of study Endophytic fungi from spines of C. castaneus were able to produce cellulase, pectinase, lipase, protease and amylase. The extracellular enzymes degraded different substrates, suggesting different types of interaction of the fungal endophytes with the host plant.

BACKGROUND: Mesenchymal stem cells (MSCs) have undergone extensive investigation for their potential therapeutic applications, primarily attributed to their paracrine activity. Recently, researchers have been exploring the therapeutic potential of extracellular vesicles (EVs) released by MSCs. METHODS: MEDLINE/PubMed and Google scholar databases were used for the selection of literature. The keywords used were mesenchymal stem cells, extracellular vesicles, clinical application of EVs and challenges EVs production. RESULTS: These EVs have demonstrated robust capabilities in transporting intracellular cargo, playing a critical role in facilitating cell-to-cell communication by carrying functional molecules, including proteins, RNA species, DNAs, and lipids. Utilizing EVs as an alternative to stem cells offers several benefits, such as improved safety, reduced immunogenicity, and the ability to traverse biological barriers. Consequently, EVs have emerged as an increasingly attractive option for clinical use. CONCLUSION From this perspective, this review delves into the advantages and challenges associated with employing MSC–EVs in clinical settings, with a specific focus on their potential in treating conditions like lung diseases, cancer, and autoimmune disorders.

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.

CASE REPORT: A BOY WITH AN INABILITY TO WALK; DO NOT FORGET ABOUT SCURVY Scurvy, a condition caused by vitamin C deficiency, is characterized by a syndrome of multisystem disorder due to defective collagen production and antioxidative function. This condition is infrequent in this modern era; thus, it is often not within the list of differential diagnoses. The broad clinical picture is generally overlooked as other systemic illnesses, resulting in an extensive investigation that delays the diagnosis. Herein, we report a case of an 8-year-old boy with underlying autism spectrum disorder who presented with lower limb pain and other constitutional symptoms. Examination revealed multiple hyperpigmented scars over the upper and lower limbs and gingival hyperpigmentation. With history of picky eating habits and clinical symptoms supported by radiographic findings, scurvy was suspected and subsequently confirmed based on a low level of ascorbic acid. With vitamin C supplementation and proper nutritional support, the patient recovered well.

Aims: Acetic acid bacteria (AAB) are a group of Gram-negative or Gram-variable bacteria that oxidise ethanol during the production of vinegar. The aim of this study was to isolate the AAB from both Lansium domesticum (Dokong) and Nephelium lappaceum (Rambutan), mother of vinegars (MV) and vinegars, as a potential starter culture for vinegar production. Methodology and results : The MV and vinegar samples were collected from six to eight weeks of fermented Dokong and Rambutan vinegar from the Food Laboratory of Universiti Malaysia Kelantan (UMK), Jeli. The enriched samples were inoculated on selective Carr and GYC solid media. From the Carr medium, thirty-seven isolates that showed a yellow clear zone and seventy-eight isolates that showed a halo clear zone on the GYC medium were selected. Sixty isolates that produced higher total acidity (>60%) were characterized by Gram staining. Sixteen Gram-negative and fourteen Gram-variable isolates were subjected to 2.0% ethanol Carr medium to select for ethanol tolerance. Five ethanol-tolerant isolates were suitable for 16S rRNA gene sequence analysis and molecular identification because they had 4% to 10% ethanol tolerance level utilisation on Carr solid medium. Based on the morphological and biochemical characteristics, isolates DV1 and RMV30 were Gram-variable. Meanwhile, RMV2, RMV19 and RMV37 were Gram-negative bacteria. RMV2, RMV19, RMV30 and RMV37 isolates were catalase-positive and oxidase negative. Only DV1 was catalase and oxidase positive. From the BLAST analysis, the obtained nucleotide sequences showed 100% homology, with RMV2, identified as Acetobacter fabarum, and DV1, RMV19, RMV30 and RMV37 were identified as A. pasteurianus. Conclusion, significance and impact of study Based on 16S rRNA gene sequences, five isolates were identified as Acetobacter species: Four isolates, DV1, RMV19, RMV30 and RMV37 strains, were identified as A. pasteurianus and RMV2 was identified as A. fabarum. DV1, RMV2, RMV19, RMV30 and RMV37 showed significant differences at (p<0.05) for ethanol utilisation at 4% and the highest toleration up to an ethanol concentration of 10%. The ability to tolerate high ethanol concentration during vinegar fermentation is a desirable in producing high acetic acid for vinegar production.

Introduction: Ozone (O3 ) is a significant component of photochemical smog as a typical secondary which is formed via nitrogen oxide photochemical interactions with volatile organic compounds (VOCs). This research discerns the complex influence of meteorological parameters and air pollutants influencing O3 concentrations. Methods: Data were acquired from 1 January 2018 until 31 December 2020 that including ozone (O3 ), nitrogen oxide (NOx), nitric oxide (NO), sulphur dioxide (SO2 ), nitrogen dioxide (NO2 ), carbon monoxide (CO), particulate matter (PM10, PM2.5), wind speed, solar radiation, temperature, and relative humidity (RH). Data were analysed using descriptive statistics in terms of line graphs. Results: The results demonstrate that the O3 concentration peaked around 14:00 hours and dropped at night (20:00 hours) owing to the lack of sunshine and redox processes. Conclusion: In conclusion, ozone precursors played an important role in ozone formation and the findings of this research are valuable for policymakers and other interested parties

Introduction: The Lost Food Project (TLFP) is a non-profit organization who continuously working on their strategic plan in combating the food insecurity problem by distributing food surplus to low income households within Klang Valley. This cross-sectional study aims to determine the socioeconomic status, food security status and its coping strategies among TLFP recipients in Klang Valley during COVID-19 pandemic. Methods: This study was conducted from April to June 2021. There were 88 respondents recruited through convenience sampling. A set of questionnaires regarding food assistance, nutrition knowledge, food security and its coping strategies was prepared, and the respondents were interviewed either by phone, face-to-face or self-administered questionnaire. Results: The prevalence of food insecurity among households in this study was 59.1%. Most of them have moderate (37.5%) to good (27.5%) nutrition knowledge. The coping strategy that most of the respondents applied was ‘using less expensive food’ (58.3%) with at least once per week within the past one month. Food insecure households tend to adopt more coping strategies compared to those food secure households (p<0.001). Moreover, households who rent their house (p<0.01), low household income (p<0.05) and high monthly food and drinks expenditure (p<0.01) were associated with the food insecurity among TLFP recipients. Conclusion: The study concluded that lower household income, higher food and drinks expenditure and those who rent the house have negative impacts on household’s food security status. Thus, the situation forced them to apply more food-related coping strategies in their daily life. Further research should be conducted on the effectiveness of TLFP in helping them to improve Malaysian’s food security status.