Spontaneous Ileal Perforation in a Case of Neutropenic Enterocolitis Managed Laparoscopically Neutropenic enterocolitis (NE) or ‘typhlitis’ is a serious condition. It is commonly associated with malignancy, intensive chemotherapy and severe neutropenia. The decision for surgery remains a clinical dilemma. We present a case of NE with ileal perforation that underwent laparoscopic small bowel resection and ileostomy. An 11 years old boy diagnosed with acute lymphoblastic leukemia, was receiving induction chemotherapy. He developed neutropenic fever which was treated with antibiotics. He subsequently experienced lower abdominal pain predominately at the right iliac fossa radiating to the suprapubic region. Abdomen examination revealed tenderness over the right iliac fossa with localised guarding. Chest X-ray erect showed no air under diaphragm. Ultrasound abdomen showed presence of minimal free fluid in the abdomen. A computed tomography abdomen was performed, which revealed evidence of pneumoperitoneum predominantly at the dependent areas of the abdomen. There was a focal defect seen at the anterior wall of distal ileum with connection with a fluid locule, suspicious of ileal perforation. The patient subsequently underwent an urgent laparoscopic small bowel resection and double barrel ileostomy. Intraoperatively, there was a 1 x 1 cm perforation at the distal ileum about 3 cm from ileocaecal junction with localised contamination. Postoperatively, the patient gradually recovered and was discharged. NE is a potentially life-threatening condition associated with high mortality. Contrary to belief, surgery in neutropenic patients is not deleterious, especially in complicated NE. Prompt and accurate decision-making holds an important role in improving patient outcomes.

Enterococcus species are Gram-positive cocci normally found in the gut but have emerged as opportunistic pathogens in healthcare settings, with rising multidrug resistance, particularly vancomycin-resistant Enterococci (VRE) posing major therapeutic challenges. This study evaluated the antibacterial and synergistic effects of plant-derived stilbenes from Reynoutria japonica against clinical VRE isolates. Ten clinical Enterococcus faecalis isolates were identified using standard morphological, biochemical, and Gram-staining methods, and antibiotic susceptibility testing. The antibacterial activity of polydatin, resveratroloside, and trans-resveratrol was assessed by agar well diffusion, and evaluation of minimum inhibitory concentrations (MICs) and evaluation of bactericidal activity concentrations (MBCs), with synergistic effects tested in combination with vancomycin.Molecular docking was performed with DapF, vanA, and gelE proteins. All isolates were resistant to vancomycin, ampicillin, imipenem, gentamicin, and ciprofloxacin but sensitive to linezolid. All three stilbenes displayed antibacterial activity. Notably, trans-resveratrol was the most active compound, with a MIC value of 0.156 mM and bactericidal activity (an MBC value equal to the MIC). Furthermore, all compounds exhibited synergistic effects when combined with vancomycin. Phytochemical analysis confirmed these stilbenes as major constituents in the root extract of R. japonica. Molecular docking studies revealed strong binding affinities of the compounds to key virulence and resistance-associated proteins (DapF, VanA, and GelE). These results indicate that transresveratrol and related stilbenes are promising candidates for development as alternative or adjunct therapeutic agents against VRE infections. Additionally, this study substantiates the traditional use of R. japonica as a source of bioactive antimicrobial compounds.

Objective: While sperm freezing (cryopreservation) is an effective method for preserving fertility, it can potentially harm the structure and function of sperm due to an increase in the production of reactive oxygen species. This study aimed to assess the impact of zinc oxide nanoparticles (ZnONPs) and selenium oxide nanoparticles (SeONPs) on various sperm functional parameters, including motility, plasma membrane integrity (PMI), mitochondrial membrane potential (MMP), acrosome membrane integrity (ACi), and malondialdehyde (MDA) levels. Methods: Semen samples were collected from 20 Albino Wistar rats. These samples were then divided into six groups: fresh, cryopreservation control, and groups supplemented with SeONPs (1, 2, 5 μg/mL) and ZnONPs (0.1, 1, 10 μg/mL). Results: Statistical analysis revealed that all concentrations of SeONPs increased total motility and progressive reduction of MDA levels compared to the cryopreservation control group (p<0.05). However, supplementation with ZnONPs did not affect these parameters (p>0.05). Conversely, supplements of 1 and 2 μg/mL SeONPs and 1 μg/mL ZnONPs contributed to the improvement of PMI and ACi (p<0.05). Yet, no significant change was observed in MMP with any concentration of SeONPs and ZnONPs compared to the cryopreservation control group (p>0.05). Conclusion The findings suggest that optimal concentrations of SeONPs may enhance sperm parameters during the freezing process.

Introduction: Poor dietary diversity is one of the key factors that increases the rate of complications during pregnancy. Pregnancy complications significantly increase the risk of maternal mortality. The aim of this study was to explore the associated factors between dietary diversity and complications during pregnancy. Method: A cross-sectional study was conducted among 450 randomly selected pregnant women. Individual dietary diversity score (IDDS) was used to assess dietary diversity based on Food Frequency Questionnaire (FFQ). IDDS was derived from 24-hour recalls from nine food groups. Results: Most of the pregnant women (48.9%) included in this study were in their second trimester; 19.3% and 31.8% were in first trimester and third trimester, respectively. About 83.8% of respondents included in this study experienced pregnancy complications. According to IDDS, most participants (77.1%) consumed a medium-diversified diet. Only 4.4% and 18.4% of pregnant women had low and highly diversified dietary intakes, respectively. Mean IDDS was 5.62±0.93, which indicated medium diversity of dietary intake. Dietary diversity had a statistically significant correlation with age (p=0.003), monthly income (p=0.003), education level (p=0.001), and respondent’s employment (p=0.004). The study exposed that pregnancy complications had a negative correlation with food diversity (r=-0.223), marriage age (r=-0.066), and education level (r=-0.163). Conclusion: The study concluded that pregnancy complications can be alleviated by improving dietary diversity practices during pregnancy.

The study aimed to compare and correlate serum levels of IL-6, 10, and 25-hydroxycholecalciferol in individuals with asthma with and without post-COVID condition (PCC). The study was designed to investigate the inflammatory response and serum 25-hydroxycholecalciferol status in asthmatics with and without PCC. A cross-sectional study of 252 subjects (128 asthmatics and 124 non-asthmatic subjects) was carried out. Interleukins and 25-hydroxycholecalciferol levels were estimated on ELISA. The principle findings were that IL-6 and 25-hydroxycholecalciferol levels were significantly increased (p<0.001), while IL-10 levels were non-significant in asthmatics with PCC compared to those without PCC. However, 25-hydroxycholecalciferol levels were significantly increased, but no significant change was observed in IL-6, and IL-10 levels in non-asthmatics with and without chronic PCC. A significant positive correlation (r = 0.258) was found between 25-hydroxycholecalciferol and IL-6 but a significant negative correlation (r = -0.227) with IL-10 in asthmatics with PCC. Similarly, a significant negative correlation (r = -0.285) was found between 25-hydroxycholecalciferol and IL-10 but was non-significant with IL-6 in asthmatics without PCC. The correlation of 25-hydroxycholecalciferol with IL-10 was significant (0.683), but IL-6 was non-significant in non-asthmatics with PCC. Multiple regression analysis showed that age, IL-6, gender, and PCC were significantly related in adjusted values to 25-hydroxycholecalciferol. This study sheds light on the complex liaison between 25-hydroxycholecalciferol levels and inflammatory responses in asthmatics, especially those with PCC. The findings suggest that although asthmatics with PCC maintain sufficient levels of 25-hydroxycholecalciferol, they show a substantial increase in the proinflammatory response. This suggests that PCC exacerbates the pro-inflammatory response in asthma. Moreover, the study reveals that asthmatics, whether with or without PCC, display a negative correlation between 25-hydroxycholecalciferol and the anti-inflammatory response. This emphasizes the main influence of asthma on the overall inflammatory response. These findings reveal a complex interplay between vitamin D levels and inflammatory mediators in asthmatic individuals with and without PCC.

Background: Malaysians, known for their diverse ethnicities, exhibit unique aesthetic features influenced by cultural nuances.Research indicates that factors including ethnicity, culture, and personal experiences affect how people perceive beauty. Objective: This study aims to address the lack of data on the preferred facial aesthetics among women from different ethnic groups in Malaysia. Methods: A questionnaire was administered to 290 Malaysian women, covering multiple regions and dimensions of facial aesthetics, including facial shape, forehead height and slope, cheekbone height, chin shape, eye region features (eyebrow shape, eyelid creases, and inner eye fold), nose (nose bridge shape, nasolabial angle, and nose width-length ratio), and lip thickness. Edited images of Asian models were used as references for facial aesthetic criteria in this study. Results: The survey revealed that the majority of participants were of Malay ethnicity (71.0%) and employed in the private sector (39.3%). The average age of the participants was 31.6±9.2 years, and most of them (66.9%) have not undergone aesthetic procedures before. Furthermore, a significant association was observed between ethnicity and women’s facial aesthetic preferences for facial shape and nasal width-length ratio (p<0.05). Oval facial shape was preferred by Malay (40.3%, n=83), Chinese (41.4%, n=12), and Indian (41.3%, n=19) women, due to its long, narrow, and rounded chin. For nasal width-length ratio, Malay (44.2%, n=91) and Chinese (37.9%, n=11) women preferred a ratio <1, whereas Indians (39.1%, n=18) favored a ratio >1. However, no significant association was found between ethnicity and other facial aesthetic criteria assessed in the study. Conclusion This study identified that Malaysian women’s preferences for facial shape and nasal width-to-length ratio are associated with ethnicity. These findings can serve as a valuable reference for aesthetic practitioners, emphasizing the importance of preservation and enhancement of unique ethnic features, customized according to the suitability of each ethnicity, rather than conforming to prevailing beauty standards.

UNRAVELLING THE ROLE OF RESIDUAL STRESS DISTRIBUTION IN THE PERFORMANCE OF BILAYERED ZIRCONIA RESTORATIONS – A NARRATIVE REVIEW Bilayered zirconia restorations have gained significant popularity in modern dentistry due to their ability to combine the strength of zirconia with the natural aesthetics provided by porcelain veneers. However, the longevity and performance of these restorations can be influenced by the distribution of residual stresses within the material. This narrative review aims to explore the impact of residual stress distribution on the longevity of bilayered zirconia restorations, focusing on factors affecting stress levels, and potential failure modes and mechanisms. A Boolean search of the PubMed database was done which yielded 40 articles, of which 26 articles were included in this review. The narrative review begins with an introduction to bilayered zirconia restorations, highlighting their composition and advantages in dental applications as well as the different veneering techniques used. Subsequently, the analysis delves into stress distribution within the restoration, emphasizing its importance in determining the restoration's mechanical behaviour. Factors influencing residual stress in bilayered zirconia are explored, material properties, sintering parameters and veneering methods. Understanding these factors is crucial for optimizing stress management during restoration fabrication. In light of the influence of residual stress on restoration durability, mitigation strategies for reducing stress levels are discussed.

EXPLORING THE USES, STERILIZATION AND STORAGE PROTOCOLS OF EXTRACTED HUMAN TEETH FOR RESEARCH ADVANCEMENTS: A SCOPING REVIEW Extracted human teeth (EHT) have long served as invaluable specimens in dental research, offering valuable insights into dental science and biomaterials. This scoping review aims to document the current uses of EHT in dental research and to identify the sterilisation and storage protocols. The study employed scoping review methods. Relevant databases (PubMed, Scopus, and Science Direct) were searched using the terms “extracted human teeth” and “in-vitro” to identify articles for inclusion. The most recent articles published over five years (2019-2023) and those in English were included. Two reviewers independently conducted the selection process, and the decision was consensually made. A descriptive statistical assessment was performed to analyse the studies involving EHT and the sterilising and storage solutions used. A total of 105 articles were reviewed: Endodontology (32%), Dental Materials (24%), Conservative Dentistry (20%), Prosthodontics (8%), Regenerative Therapy (6%), Oral Biology (5%), Orthodontics (4%), and Periodontology (3%). 71% of the reviewed papers did not report the sterilising and storage methods for EHT. When reported, sodium hypochlorite was most commonly used (15%). However, the concentrations and immersion time in the sterilising solutions were inconsistent. The most frequently used storage solutions to keep EHT from dehydration are saline (11%) and distilled water (10%). In conclusion, extracted human teeth continue to be extensively utilised in dental research. Nonetheless, the reporting and standardisation of sterilisation and storage methods are notably inadequate. A standardised guideline for sterilising and preserving extracted human teeth for various types of research is essential to mitigate variability and promote result uniformity. There is a stark absence of consensus regarding the optimal procedures for storing and sterilising EHT, even when used for the same laboratory investigations and different types of dental research.

COVID-19 is a highly contagious disease that caused a worldwide pandemic in 2020. Medical students are public advocates for COVID-19 vaccination to achieve herd immunity. Our objective is to ascertain the level of knowledge, attitude, and practice toward COVID-19 immunisation among medical students in Malaysia. The online study included four public universities in Peninsular Malaysia: Universiti Putra Malaysia, International Islamic University Malaysia, Universiti Sains Malaysia and Universiti Sains Islam Malaysia. Data collected include sociodemographic characteristics, history of COVID-19 infection, knowledge, attitude and practice towards COVID-19 immunisation. Analytical statistics were analysed with IBM Statistical Package Statistical Package for the Social Science (SPSS) v27.0 using Pearson chi-square or Fisher’s exact test (significant if p < 0.05). From the total of 427 respondents, 60.2% had good knowledge whereby clinical students 67.0% had a higher proportion of good knowledge as compared to preclinical students 53.5% (p = 0.004). Respondents in the age group of 21 to 24 years old (p < 0.001) and 25 to 29 years old (p = 0.016), and Indian ethnicity (p = 0.006) were more likely to have good knowledge. Respondents registered in Malaysia’s National COVID-19 vaccination program were considered as having a positive attitude (n = 264, 61.8%). A vaccination rate of 100% was observed. In conclusion, 60.2% of medical students had good knowledge, 61.8% had a positive attitude and 100% were vaccinated in these four public medical schools in Malaysia. Sociodemographic factors (age group and Indian ethnicity) have an association with only good knowledge but none with the level of attitude and practice towards COVID-19 immunisation.
COVID-19