Introduction: Clinically important drug–drug interactions are a frequently overlooked cause of severe hypoglycemia in patients with type 2 diabetes mellitus (T2DM). Gliclazide is primarily metabolized via cytochrome P450 2C9 (CYP2C9), while fluconazole is a potent inhibitor of this enzyme.1,2 Concomitant administrations markedly increase gliclazide plasma concentration and prolong its hypoglycemic effect, substantially increasing the risk of severe and prolonged hypoglycemia. In some cases of refractory sulfonylureainduced hypoglycemia, octreotide may need to be considered early. Case: A 63-year-old Malay female with a 15-year history of T2DM on maximum-dose gliclazide (320 mg/day) presented with syncope and recurrent severe hypoglycemia 5 days after receiving a single oral dose of fluconazole 150 mg for a superficial fungal skin infection. Her other antidiabetic medications included metformin 1 g twice daily and vildagliptin 50 mg once daily. Her blood pressure on presentation was 151/74 mmHg, and her glucose level was 2.8 mmol/L. Her presentation was compounded by community-acquired pneumonia and acute kidney injury (estimated glomerular filtration rate 52 mL/min/1.73 m²). Biochemical evaluation excluded adrenal insufficiency, with normal serum cortisol (1,098 µg/dL), serum sodium (141 mmol/L), and serum potassium (4.6 mmol/L). Thyroid and liver function tests were normal. Despite repeated boluses of 50% dextrose and continuous infusion of 20% dextrose, recurrent hypoglycemia persisted for up to 48 hours after discontinuation of gliclazide, with glucose ranging from 1.7 to 5.1 mmol/L, reflecting prolonged sulfonylurea activity. Conclusion This case highlights a clinically significant yet preventable interaction between fluconazole and gliclazide, mediated through CYP2C9 inhibition, resulting in sustained hyperinsulinemic hypoglycemia. Gliclazide should be reduced or withheld prior to initiating fluconazole, and medication review should be performed at every consultation.
Fluconazole ; Gliclazide ; Hypoglycemia

Accessibility to Oral Health Care Services and Oral Health-Related Quality of Life Among Children with Cerebral Palsy Children with cerebral palsy (CP) are highly dependent on their caregivers to access oral health care services (OHS), which leads to unmet oral health needs that affect their oral health-related quality of life (OHRQoL). This study explored accessibility to OHS and OHRQoL among children with CP attending Community-Based Rehabilitation (CBR) centres in Kelantan by their primary caregivers. A cross-sectional study using Accessibility to Oral Health Care Services (CP2OHS) and Parental-Caregiver Perception Questionnaire (P-CPQ) was conducted on 81 children with CP and their primary caregivers. CP2OHS domains are “ability to perceive”, “ability to engage”, “ability to seek”, “ability to pay”, and “ability to reach”, while PCPQ domains include oral symptoms, functional limitation, emotional wellbeing, and social well-being. Children with CP were mostly males (63.0%), with a mean (SD) age of 10.3 (3.93) years, Gross Motor Function Classification System (GMFCS) Level V (46.9%), and Communication Function Classification System (CFCS) Level III (33.3%). Their caregivers were mainly female (85.2%), aged 43.6 (9.34) years. The mean (SD) total score for CP2OHS was 29.67 (10.81) of –56 to 56 and P-CPQ was 13.21 (5.89) of 8 to 40. There was a significant difference in accessibility scores between tertiary, lower secondary, and primary levels of education (p = 0.009); village and city/ town residents (p = 0.013); and transportation with personal car and motorcycle (p = 0.004). The Pearson analysis revealed a weak positive correlation between accessibility and OHRQoL scores (r = 0.158, p = 0.16) that was not statistically significant. Children with CP posed high CP2OHS scores and low P-CPQ scores, indicating high accessibility to OHS and high OHRQoL. Strengthening OHS utilisation among these children is crucial for a better quality of life for them.

We reported a case of recurrent subcutaneous swelling on the left foot of a diabetic patient. Two different organisms, Cladosporium spp. and Phaeoacremonium krajdenii were isolated, both of which are associated with phaeohyphomycosis and eumycetoma. The cure was achieved through surgical excision of the lesion and a course of antifungal therapy. The diagnosis was uncertain since clinical manifestations and laboratory results were insufficient to distinguish the two diseases.

Introduction: Obesity has been linked to coronary artery disease, type II diabetes, metabolic syndrome, stroke, and cancer. Pomegranate (Punica granatum; PG) has been used extensively in folk medicine for several therapeutic purposes. The goal of this study is to investigate the anti-obesity effect of PG peel and pulp methanolic extracts in highfat diet (HFD)-induced Sprague-Dawley rats. Methods: The animals were separated into 7 groups namely Normal control group (normal diet); HFD-induced only as negative control group, and positive control group (HFD-induced + orlistat); treatment group included HFD-induced + peel 125 mg/kg, HFD-induced +peel 250 mg/kg, HFD-induced + pulp 125 mg/kg and HFD-induced + pulp 250 mg/kg. Results: It was observed that methanolic extract of peel and pulp PG 250 mg/kg showed low increment of body weight with a reduction in weight of liver, visceral fat, and subcutaneous fat. Compared to the negative control group, total cholesterol, triglyceride, and low-density lipoprotein levels were shown to be lowered for PG peel and pulp groups also showed higher values in high-density lipoprotein. Conclusion: PG reduced obesity-related markers in blood, liver, and adipose tissue and inhibited obesity caused by a high-fat diet probably because of its antioxidant properties.

Aims: Hypoxia is believed to be one of the key components contributing to the clinical resistance of cancer therapies. Alternative strategies are under investigation to overcome this resistance and the oncolytic virus stands amongst the others. Newcastle disease virus (NDV) has been demonstrated to possess oncolytic activity against cancer cells. The present study investigated the effects of oncolytic NDV strain AF2240 and V4-UPM on osteosarcoma cells (Saos-2) under normoxic and hypoxic conditions. Methodology and results: Results showed that the NDV strain AF2240 and V4-UPM could infect and kill normoxic and hypoxic Saos-2 cells equally well by inducing hypoxia-independent apoptosis, and S-phase cell cycle arrest under the microscopy examination, cell viability assay, Annexin V apoptosis assay and cell cycle analysis experiments. However, the Velogenic NDV strain AF2240 excelled over the lentogenic NDV V4-UPM with increased oncolytic effects in Saos-2 cells. Conclusion, significance and impact of study In a nutshell, normoxia or hypoxia microenvironment has little effect on NDV-induced oncolysis of Saos-2 cancer cells which poses as a potential agent for the treatment of resistant cancer.

Deletions and amplifications of genes often occur during multistep progression from oral precancer, seen as oral epithelial dysplasia (OED) to cancerous stage. These genetic alterations could be used as markers to aid in detection of oral squamous cell carcinomas (OSCC). This study explored the use of multiplex ligation-dependent probe amplification (MLPA) technique in detecting OSCC and OED specific genetic alterations. MLPA was used to detect gains and losses of 106 genes in DNA extracted from frozen tissue samples of 10 OSCC and 10 noncancer patients. Two biopsies of OED were analyzed to explore the alterations in oral potentially malignant disorders. There were significant differences (p<0.001) in the number of alterations in OSCC and dysplasia compared to non-cancer samples respectively. The most frequently altered genes in OSCC were PTP4A3, RECQL4, ATM, and KLK3 (60%). Five genes (MYC, SLA, TNFRSF1A, MESDC1, MIF) were altered in 50% of OSCC samples. These nine genes were specific to OSCC samples (p<0.05). Some genes, including MYB, MET, CASP2, SLA and PTEN occurred in 50% of OED samples. MLPA was able to detect genetic alterations, that are present only in the OSCC samples and showed potential to be used as an adjunctive tool in early diagnosis of OSCC.

Objective: To investigate how gait parameters in children with traumatic brain injury (TBI) versus typically developing (TD) children are influenced by secondary concurrent tasks and examine the correlations between gait parameters and attention and balance in children with TBI. Methods: Sixteen children with TBI (mean age, 11.63±1.89 years) and 22 TD controls (mean age, 11.41±2.24 years) participated in this case-control study. Attention and functional balance were measured using the Children’s Color Trail Test (CCTT) and Pediatric Balance Scale (PBS). All participants first walked without concurrent tasks and then with concurrent motor and cognitive tasks. The APDM Mobility Lab was used to measure gait parameters, including gait velocity, stride length, stride duration, cadence, and double support time. Repeatedmeasures analysis of variance and Spearman correlation coefficient were used for the analysis. Results: Children with TBI showed significantly more deterioration in gait performance than TD children (p<0.05). Concurrent tasks (motor and cognitive) significantly decreased gait velocity and cadence and increased stride time; the differences were more obvious during the concurrent cognitive task. A moderate correlation was found between gait parameters (gait velocity and stride length) and CCTT-2 and PBS scores in children with TBI. Conclusion Gait performance may be affected by task complexity following TBI. Attention and balance deficits caused deterioration in gait performance under the concurrent task condition in children with TBI. This study illustrates the crucial role of task demand and complexity in dual-task interference.

Objective: To investigate how gait parameters in children with traumatic brain injury (TBI) versus typically developing (TD) children are influenced by secondary concurrent tasks and examine the correlations between gait parameters and attention and balance in children with TBI. Methods: Sixteen children with TBI (mean age, 11.63±1.89 years) and 22 TD controls (mean age, 11.41±2.24 years) participated in this case-control study. Attention and functional balance were measured using the Children’s Color Trail Test (CCTT) and Pediatric Balance Scale (PBS). All participants first walked without concurrent tasks and then with concurrent motor and cognitive tasks. The APDM Mobility Lab was used to measure gait parameters, including gait velocity, stride length, stride duration, cadence, and double support time. Repeatedmeasures analysis of variance and Spearman correlation coefficient were used for the analysis. Results: Children with TBI showed significantly more deterioration in gait performance than TD children (p<0.05). Concurrent tasks (motor and cognitive) significantly decreased gait velocity and cadence and increased stride time; the differences were more obvious during the concurrent cognitive task. A moderate correlation was found between gait parameters (gait velocity and stride length) and CCTT-2 and PBS scores in children with TBI. Conclusion Gait performance may be affected by task complexity following TBI. Attention and balance deficits caused deterioration in gait performance under the concurrent task condition in children with TBI. This study illustrates the crucial role of task demand and complexity in dual-task interference.

Objective: In this present study, we aim to evaluate the accuracy of the HbA1c relative to fasting plasma glucose (FPG) in the diagnosis of diabetes and pre-diabetes among The Malaysian Cohort (TMC) participants. Methodology: FPG and HbA1c were taken from 40,667 eligible TMC participants that have no previous history of diabetes, aged between 35-70 years and were recruited from 2006 – 2012. Participants were classified as normal, diabetes and pre-diabetes based on the 2006 World Health Organization (WHO) criteria. Statistical analyses were performed using ANOVA and Chi-square test, while Pearson correlation and Cohen’s kappa were used to examine the concordance rate between FPG and HbA1c. Results: The study samples consisted of 16,224 men and 24,443 women. The prevalence of diabetes among the participants was 5.7% and 7.5% according to the FPG and HbA1c level, respectively. Based on FPG, 10.6% of the participants had pre-diabetes but this increased to 14.2% based on HbA1c (r=0.86; P<0.001). HbA1c had a sensitivity of 58.20 (95% CI: 56.43, 59.96) and a specificity of 98.59 (95% CI: 98.46, 98.70). Conclusion A higher prevalence of pre-diabetes and diabetes was observed when using HbA1c as a diagnosis tool, suggesting that it could possibly be more useful for early detection. However, given that HbA1c may also have lower sensitivity and higher false positive rate, several diagnostic criteria should be used to diagnose diabetes accurately.
Diabetes Mellitus, Type 2 ; Diagnosis

Introduction: Ultraviolet (UV) A is the longest wavelength of UV radiation, accounts for approximately 95% of the radiation reaching the earth's surface. It can penetrate deeply into the skin layer and able to induce photoaging and photocarcinogenesis through the activation of reactive oxygen species (ROS). Polysaccharides-containing Pleurotus flabellatus (known as a pink oyster mushroom) has antioxidative properties and may inhibit free radical activities generated from UV radiation. Hence, this present study was to evaluate the antioxidative and photoprotective properties of exopolysaccharides (ExPFE) and exopolysaccharides (EnPFE) of Pleurotus flabellatus extracts on UVA irradiated human dermal fibroblast (HS-27) cell line. Methods: The antioxidant level of ExPFE and EnPFE was determined using 1,1-Diphenyl-2-picrylhydrazyl (DPPH) scavenging assay, while both cytotoxicity and photoprotective effects of the extracts on the HS-27 cell line were determined using CellTiter-Blue® cell viability assay. The effects of ExPFE and EnPFE on the HS-27 cell migration was evaluated using the scratch assay. Results: Both ExPFE and EnPFE exhibited respectable antioxidant and scavenging activity in DPPH. The extracts also demonstrated a non-cytotoxicity, but photoprotective effects to the HS-27 cells by increasing the percentage of cell viability and enhancing cell migration activity upon UVA exposure. Conclusion: The ExPFE and EnPFE exhibit antioxidative and photoprotective effects on UVA irradiated HS-27 cell line. This study suggests that pink oyster polysaccharides could be a potential natural bioactive compound for skin protection against UVA radiation.