Thioacetamide (TAA)-induced liver fibrosis, triggered by inflammation and oxidative stress, is prompted by hepatic stellate cells (HSCs) activation via several pathways. This study explores the hepatoprotective effect of aloe vera gel (AVG) extract and bone marrow mesenchymal stem cells (BM-MSCs) transplantation on regulating long intergenic noncoding RNA (lincRNA-p21) and microRNA (miR-17-5p) expressions and their impact on TGF-β1/Smad-3 and Wnt-10a/ β-Catenin cascades in TAA-induced liver damage. The study involved 48 adult male albino rats divided into four groups:control, TAA, TAA treated with BM-MSCs, and TAA treated with BM-MSCs+AVG extract. After 8 weeks, liver enzymes and hepatic oxidative parameters were evaluated alongside lincRNA-p21, miR-17-5p, TGF-β1, Smad-3, Wnt-10a, and β-Catenin expressions. Liver tissue sections were examined by light and electron microscopes and analyzed morphometrically. Group II showed increased aspartate aminotransferase, alanine aminotransferase, malondialdehyde, reduced glutathione levels, and deteriorated hepatocytes with distorted mitochondria and dilated rough endoplasmic reticulum. Group IV restored lincRNA-p21 expression, which downregulated miR-17-5p and suppressed activated HSCs by inhibiting TGF-β1/Smad-3 and Wnt-10a/β-Catenin pathways, and improved hepatic tissue architecture. Additionally, immunohistochemically, alpha-smooth muscle actin and cyclin D1 expressions were markedly decreased in group IV compared to group II. We concluded that AVG suppresses fibrotic pathways, boosts BM-MSCs differentiation, and reduces HSCs activation in liver fibrosis caused by TAA.

Background: s/Aims: Portal vein embolization (PVE) and Yttrium-90 (Y-90) radioembolization are used to induce liver hypertrophy, increasing future liver remnant volume and reducing the risk of post-resection liver failure. This systematic review compares the effectiveness of PVE and Y-90 radioembolization in promoting liver hypertrophy in patients undergoing liver resection. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, Cochrane, and Web of Science were searched for studies published between January 2000 and August 2023. Studies comparing PVE and Y-90 radioembolization with respect to liver hypertrophy were included. Risk of bias was assessed using the Newcastle–Ottawa Scale. Pooled mean differences were calculated using an inverse-variance random-effects model. Results: Of 1,965 studies identified, three retrospective cohort studies met inclusion criteria, comprising 125 patients. Among these, 67.3% underwent PVE and 32.7% received Y-90 radioembolization. Hepatocellular carcinoma was the most common diagnosis (55.9%), followed by metastatic disease (32.3%) and cholangiocarcinoma (11.8%). PVE was more commonly used as a preoperative strategy for liver resection, while Y-90 radioembolization was primarily employed for palliative intent. One study reported greater hypertrophy with Y-90 compared to PVE (63% vs. 36%); however, hypertrophy was assessed over a longer interval (150 vs. 30 days). In pooled analysis, PVE was associated with significantly greater hypertrophy (mean difference 23.75%; 95% CI 12.02–35.48; p < 0.0001; I 2 = 48%). Conclusions Evidence directly comparing PVE and Y-90 radioembolization for liver hypertrophy remains limited. While pooled results favor PVE, procedure selection should be individualized based on clinical context.

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

Background: and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. Methods: This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Results: Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04). Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.

OCCUPATIONAL STRESS, COPING STRATEGIES, AND QUALITY OF LIFE AMONG NURSES IN ABHA CITY Background: The nursing profession is inherently stressful, and nurses in Abha City face unique challenges due to rapid population growth and evolving healthcare needs. Objective: The purpose of the present study is to identify the correlation between “Occupational stress, coping strategies and quality of life” among nurses in Abha city. Method: The present study utilized a cross-sectional, descriptive survey, and correlational research design. A convenience sampling throughout an online questionnaire was used to recruit 411 nurses from three hospitals in Abha city, and data was collected using three validated instruments: The Expanded Nursing Stress Scale, the Brief Cope Scale, and the World Health Organization-Quality of Life Scale. SPSS version 26 was used for data analysis, including descriptive statistics, independent samples t-test, ANOVA, and Pearson’s correlation coefficient. Results: Findings revealed a moderate level of occupational stress (mean score 2.31 ± 0.56 on the ENSS-59 scale), with the main sources being dealing with patients and their families (2.35 ± 0.65), uncertainty concerning treatment (2.33 ± 0.66), and discrimination (2.32 ± 0.88). Nurses employed coping strategies such as planning (2.49 ± 0.75), religion (2.47 ± 0.72), and substance use (2.45 ± 0.77), while the least adopted strategies were self-blame (2.40 ± 0.71), self-distraction (2.37 ± 0.73), and behavioral disengagement (2.32 ± 0.73). Significant associations were found between sources of occupational stress and coping strategies, such as death and dying stress source correlating with self-distraction (r=0.202), use of instrumental support (r=0.111), positive reframing (r=0.154), humor (r=0.111), religion (r=0.142), and self-blame (r=0.141). Conflict with peers as a stress source was significantly correlated with self-distraction (r=0.157), denial (r=0.158), substance use (r=0.183), use of instrumental support (r=0.130), behavioral disengagement (r=0.106), venting (r=0.121), humor (r=0.203), religion (r=0.106), and self-blame (r=0.152). A significantly negative association between occupational stress and quality of life was also identified (r=-0.451). Conclusion: Significant correlation were found between sources of occupational stress and coping strategies. The study also demonstrated a significant negative association between occupational stress and quality of life, emphasizing the need for interventions to reduce occupational stress and enhance nurses’ well-being. ASEAN Journal of Psychiatry, Vol. 25 (2) February, 2024; 1-14.

Background: Corona anxiety is present in medical students who must attend hospital. Due to the prevalence of Coronavirus Disease (COVID-19) disease and more attention to holding virtual classes and the need to pay attention to corona anxiety in inter-ship students of nursing, midwifery and operating room, this study aims to determine the impact of virtual education on transmission, control and Prevention of COVID-19 disease due to corona anxiety was performed in these students. Materials and methods: This quasi-experimental study was performed on 90 internship students of nursing, midwifery and operating room. The instruments of this study included the Demographic Profile Questionnaire and the Corona Disease Anxiety Scale (CDAS). In the intervention group, e-learning on methods of transmission, prevention and treatment of coronavirus in 6 sessions of 45 minutes three times a week (for two weeks) online by creating an educational channel for group discussion and information exchange and another channel only for Educational content was provided in WhatsApp Independent t-test was used to compare the mean and standard deviation of coronavirus anxiety scores between the two groups, before the intervention and after the intervention. Data were analyzed using SPSS software version 21, and paired t-test was used to compare the mean scores in each group before and after the intervention. Results: The mean and standard deviation of the age of the research units was 23.02 ± 1.3. The results of independent t-test showed that after the intervention, there was no significant difference between the intervention and control groups in terms of mean score of coronary anxiety (p>0.05). The results of paired t-test showed that there was no statistically significant difference in the mean score of coronavirus anxiety in the intervention and control groups before and after the intervention (p>0.05). Conclusion: The results of this study showed that virtual education did not have a significant effect on reducing anxiety caused by Corona virus and the mean score of students’ anxiety did not change. This indicates proper planning and education about this disease in the country and achieving the goal of increasing people’s awareness by the Ministry of Health, Treatment and Medical Education and it is recommended that the training be directed to students other than the medical sciences and others.

Introduction: SABINA III assessed short-acting β2-agonist (SABA) prescription patterns and their association with asthma-related outcomes globally. Herein, we examined SABA prescription and clinical outcomes in the Malaysian cohort of SABINA III. Methods: In this observational, cross-sectional study, patients (≥12 years) were recruited between July and December 2019 from 15 primary and specialty care centres in Malaysia. Prescribed asthma treatments and severe exacerbation history within 12 months prior and asthma symptom control during the study visit were evaluated. Associations of SABA prescription with asthma control and severe exacerbation were analysed using multivariable regression models. Results: Seven hundred thirty-one patients (primary care, n=265 [36.3%]; specialty care, n=466 [63.7%]) were evaluated. The prevalence of SABA over-prescription (≥3 SABA prescriptions/year) was 47.4% (primary care, 47.1%; specialty care, 47.6%), 51.8% and 44.5% among all patients and patients with mild and moderate-to-severe asthma, respectively. Altogether 9.0% (n=66) purchased SABA without a prescription; among them, 43.9% (n=29) purchased ≥3 inhalers. The mean (standard deviation) number of severe asthma exacerbations was 1.38 (2.76), and 19.7% (n=144) and 25.7% (n=188) had uncontrolled and partly controlled symptoms, respectively. Prescriptions of ≥3 SABA inhalers (vs 1–2) were associated with lower odds of at least partly controlled asthma (odds ratio=0.42; 95% confidence interval [CI]=0.27–0.67) and higher odds of having severe exacerbation(s) (odds ratio=2.04; 95% CI=1.44–2.89). Conclusion The prevalence of SABA over-prescription in Malaysia is high, regardless of the prescriber type, emphasising the need for healthcare providers and policymakers to adopt latest evidence-based recommendations to address this public health concern.
Asthma ; Malaysia

Background: and Purpose Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). Methods: This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). Results: Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P<0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0–2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P<0.001), and better discharge NIHSS (P<0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P<0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence. Conclusion In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients’ age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.

SOCIAL SUPPORT AND THE ASSOCIATED RISK FACTORS FOR POSTPARTUM DEPRESSION AMONG MOTHERS ATTENDING PRIMARY CARE CENTERS IN MALAYSIA. Abstract Background/Objectives: Postpartum Depression (PPD) is the most common maternal distress worldwide. PPD negatively impacts mothers, infants, and the family, affecting psychosocial and economic well-being. The study aims to determine the prevalence of Postpartum Depression in mothers attending primary care centres and the associated risk factors, including perceived social support and breastfeeding experiences. Methods: This cross-sectional study assessed 230 mothers up to three months postpartum attending two maternal and child clinics in Alor Setar, Kedah, Malaysia, from August to November 2022. Three self-report measures were used, namely the sociodemographic and clinical questionnaires, The Edinburgh Postnatal Depression Scale (EPDS) to assess depression and the Multidimensional Scale of Perceived Social Support (MSPSS) to measure the level of perceived social support. Results: The prevalence of Postpartum Depression was 2.6%. Univariate analysis found that duration of postpartum, employment status, income groups, depressed mood during pregnancy and presence of breastfeeding difficulties were significantly associated with Postpartum Depression. Predictors of Postpartum Depression were the high-income group (P 0.044 or 10.76 95% CI 1.07-108.76), depressed mood during pregnancy (P 0.026 or 8.31 95% CI 1.29-53.47) and breastfeeding difficulties (P 0.018 or 15.14 95% CI 1.59-144.54). Conclusion: Postpartum Depression is prevalent in the community. General and targeted Postpartum Depression screening should be done early. Breastfeeding educators’ services should be feasible for the mother to reduce the risk of Postpartum Depression.

Objectives: Voluntary testing (VT) plays a crucial role in the prevention and control of infectious diseases. The present study investigated the perceptions and utilization of VT services for coronavirus disease 2019 (COVID-19) among the inhabitants of Saudi Arabia. Methods: In total, 3,510 adult participants from all provinces of Saudi Arabia were recruited via a national online survey. Results: Of the 3,510 participants, 88.9% were aware of the testing services available to them and of those, more than half (59.5%) had used the VT services and 96.1% were satisfied with the services. Contact with a positive COVID-19 case was the top reason for accessing VT, while a lack of awareness about the availability of VT services was the top perceived limiting factor. A history of chronic health conditions, anxiety and/or depression, and previous symptoms suggestive of COVID-19 were found to be predictors of the utilization of VT services (OR 1.55, 95% CI 1.22−1.96; OR 1.48, 95% CI 1.16−1.88; OR 3.31, 95% CI 2.77−3.95; and OR 1.62, 95% CI 1.34−1.96; respectively), respectively. Conclusion The awareness of voluntary COVID-19 testing services was satisfactory among the Saudi Arabian population, but can be improved. Sociodemographic and health history predictors of the utilization of VT services were identified.