Introduction: Leukemia is one of the most prevalent childhood cancers, accounting for 30% of paediatric cancers globally and 39.1% in Malaysia. This study assesses neuropsychological functioning in childhood Acute Lymphoblastic Leukemia (ALL) survivors, including executive functioning, attention span, working memory, problem solving, processing speed, cognitive flexibility, and inhibitory control. Methods: Twenty-seven childhood ALL survivors (12 males, 15 females), aged 8–26 years and in remission for at least one year, were recruited from Hospital Pakar Universiti Sains Malaysia. Participants completed the Wechsler Intelligence Scale: Digit Span and subtests from the Delis-Kaplan Executive Function System: Trail Making Test, Verbal Fluency, Colour-Word Interference, and Sorting Test. Results: Results revealed significant neuropsychological deficits compared to normative data. Working memory performance (Digit Span, M = 6.63) was significantly below the mean. Impairments in executive functioning were found in Trail Making Test scores, particularly in Visual Scanning (M = 6.78), Letter Sequencing (M = 4.30), and Number-Letter Sequencing (M = 4.70). Verbal Fluency deficits were most notable in Letter Fluency (M = 4.70). Cognitive flexibility challenges were indicated by Colour-Word Interference scores (Inhibition, M = 8.04; Inhibition/ Switching, M = 8.26). Sorting Test scores (M = 7.33) indicated categorization difficulties. Correlations showed that school and post-treatment duration positively affected task performance, while earlier diagnosis negatively affected cognitive flexibility. Conclusion: These findings highlight neuropsychological deficits in Malay childhood ALL survivors, emphasizing the need for tailored interventions and screening tools to improve their quality of life and address gaps in understanding long-term effects.

TRACHEA INJURY IN A POLYTRAUMA PATIENT WITH AN INTRATHORACIC MIGRATION OF FOREIGN BODIES Traumatic airway injuries with intrathoracic foreign body migration are rare but can be severe and life-threatening. Prompt clinical suspicion is crucial to secure the airway and prevent further respiratory distress. Imaging is important in depicting the nature of the injury and its possible complications. We are reporting the case of a 26-year-old motorcyclist who was involved in a high-velocity road traffic accident and had extensive polytrauma with an airway injury. He was intubated and required an urgent thoracostomy for the pneumothorax. Computed tomography revealed trachea injury with intrathoracic and mediastinal foreign body migration. The patient was planned for a thoracotomy or video-assisted thoracoscopic surgery (VATS) approach for the removal of the foreign bodies. However, his condition gradually deteriorated, and he passed away due to a severe head injury.

Cobra bite envenomation is one of the commonest causes of snake related injuries in Malaysia. Local tissue injury following a cobra bite is a complex sequalae of envenomation that is attributed to various peptides and enzymes including cytotoxin, metalloproteases, phospholipase A2 and hyaluronidase. This case involves a young construction worker who was bitten by an unidentified snake on the dorsum of his left foot. He presented with typical features of local and systemic envenomation of a Naja species. Remote Envenomation Consultancy Services was consulted and the appropriate antivenom was administered. The patient underwent wound debridement and subsequent skin grafting. Follow up at outpatient clinic showed good skin graft uptake and recovery. Managing a significant Naja species bite envenomation can be a lengthy process requiring expertise from various subspecialties. Timely and seamless multidisciplinary approach in managing a Naja species envenomation ensures a favorable outcome with minimal complication..

Introduction: Aquilaria malaccensis, also known as “Pokok Karas” in Malaysia, is widely used in Southeast Asian countries for the treatment of joint pain, diarrhoea and inflammatory diseases, and has shown beneficial effects as an anticancer agent. The aim of this study was to investigate the effect of ethanol leaf extracts of A. malaccensis on MCF-7 cells. Methods: MTT-based cytotoxic and antiproliferative assay was used to determine the outcome of ethanolic extract toward MCF-7 cells. The mode of cell death was determined by the AO/PI double staining assay and the depolarisation of the mitochondria membrane potential. Results: IC50 value of the extract against MCF-7 cells treated for 72 hours was 4.1 ± 2.08 µg/mL, while the IC50 value for doxorubicin was 2.92 ± 0.12 µg/mL. The extract showed a lower cytotoxic effect against the NIH/3T3 cells and inhibited the growth of MCF-7 cells in a dose dependent manner. AO/PI double stain showed that the ethanolic extract of A. malaccensis leaves induced MCF-7 cells into apoptotic cell death. The present study showed that the ethanolic extract of A. malaccensis induced apoptosis through mitochondrial pathway as indicated by its ability to take up JC-1. Conclusion: The study found that ethanolic extract obtained from A. malaccensis leaves is cytotoxic on MCF-7 cells, resulting to apoptotic cell death of the cells.

Introduction: The COVID-19 pandemic has forced revolutionary changes in the delivery of medical education and imposed much stress on medical students and academicians. This study aimed at evaluating the level of exposure to COVID-19, COVID-related functional difficulties and concerns experienced by medical students, approximately one year after COVID-19 became significant health and socio-economic issues in Malaysia. Methods: A cross-sectional study using self-administered online questionnaire, was conducted among the undergraduate medical students of a private university in Malaysia. Results: A total of 243 medical students participated. They reported low level of exposure to COVID-19 infection. Majority of them demonstrate moderate level of difficulties in learning (median score of 3, highest score = 4) and high levels of COVID-related concerns (median scores of 4 to 5, highest score = 5). Lowest household income category was a significant predictor of high level of functional difficulties (OR = 3.878, 95%CI: 1.651, 9.110); whilst female gender was a significant predictor of high level of COVID-related concerns (OR = 7.400, 95%CI: 1.920, 28.514). Conclusion: One year following the onset of COVID-19 pandemic in Malaysia, medical students still reported significant functional difficulties in learning and demonstrated high levels of COVID-related concern. Collaborative efforts to mitigate the problems need to be intensified with emphasis on the delivery of online medical education and special attention to female and lower socio-economic group students to prevent detrimental consequences to medical students and medical education. Multi-center and longitudinal studies are recommended.

Introduction: Type 2 diabetes mellitus is a chronic disease which is highly prevalent in Malaysia. In managing diabetes, the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) have advocated self-management to be the basic component of diabetes care. However, an ongoing discussion, education and assessment of the patient’s diabetic knowledge should be implemented in the patient’s empowerment process. There are various assessment tools available worldwide but very few are available in the Malay language. This study is aimed to perform the Malay translation of the Simplified Diabetes Knowledge Test (DKT) questionnaire and validate it. Methods: Forward-backward translation procedure was used to translate the simplified version of the DKT questionnaire. A total of 120 respondents with type 2 diabetes mellitus from a selected government health clinic were recruited to answer the questionnaire which consists of socio-demographic, diabetes characteristics and the 20-item Malay version of simplified DKT questionnaire. Reliability and construct validity were tested with Cronbach’s alpha coefficient and Exploratory Factor Analysis. Results: Factor analysis with Varimax rotation identified five meaningful domains for the final 18 items. The Cronbach’s alpha for the overall scale of the translated questionnaire was 0.573 with values of each five significant domain’s Cronbach’s alpha ranged from 0.370 to 0.564. Conclusion: The Malay version of simplified DKT is valid and reliable to be used as a brief assessment of knowledge among Malaysian diabetic patients.

Speech and language skills are among the crucial components in determining cochlear implant habilitation outcomes. The purpose of this study was to investigate speech and language skills of Malay cochlear implant children using a developmental scale questionnaire and to identify the demographic factors that contribute to their performance. This study involved 26 children recruited from the National Cochlear Implant Program under the Malaysian Ministry of Health with chronological ages between 33 to 99 months (mean=72, SD=18.9), implant ages between 18 to 71 months (mean=40, SD=13.5) and hearing ages between 13 to 48 months (mean=30, SD=10.5). The instrument used was The Integrated Scale of Development-Malay version 2 (ISD-Mv2). The questionnaires were given to the parents or caregivers followed with by a phone call interview later. Results from the study showed that only 9 subjects (35%) were able score on the ISD-Mv2 equally or higher than their hearing age. From the six components in the ISD-Mv2, cognitive was scored the highest with 96.79% meanwhile expressive language was the lowest with 76.21%. Pearson correlation test revealed strong positive correlation between audition-receptive language (r=0.554, p<0.05) and cognitive–social communication/ pragmatic (r= 0.625, p<0.05). Speech and language performance of children with demographic factors did not show significant differences. The findings suggests that majority of the Malay cochlear implant children demonstrated delayed speech and language performance as compared to normal hearing children.

Histoplasmosis usually occurs in immunocompromised patients through the dissemination of the fungus from lungs to other organs but laryngeal involvement is rare. We report a 52-year-old male chronic smoker who presented with hoarseness for 3 months was initially investigated for laryngeal carcinoma. However biopsy showed granulomatous inflammation. He was treated with anti-tuberculosis treatment for 2 months but symptoms persisted and a repeat biopsy revealed laryngeal histoplasmosis. There were no sign and symptoms of pulmonary or systemic involvement. Treatment with intravenous amphotericin B and oral itraconazole lead to complete resolution of symptoms and signs. Monitoring and early revisiting the diagnosis are important when a patient’s symptoms do not improve with the treatment. Further investigation including a repeat biopsy of lesion is vital to establish the diagnosis and lead to appropriate management.

Introduction: Human teeth tend to stain from intrinsic and extrinsic factors with time. The study was aimed to assess colour change of stained enamel after the use of bleaching agents. Methods: 63 extracted human teeth were selected and soaked in the coffee solution for 7 days to stain the teeth. Then they were randomly divided into 3 groups (n = 21). The groups were divided as the control group (distilled water), group using 6% carbamide peroxide (CP6) and group using 9% carbamide peroxide (CP9). The groups of CP6 and CP9 were bleached with 0.2 ml of bleaching agent for 5 minutes daily until 14 days. Colour changes were visually recorded by using VITA Toothguide 3D-MASTER and Ocean Optics Spectrometer instrument. Results: CP6 started to show shade reduction on Day 3 (score 5), followed by a steady reduction until Day 10. Day 12 to 14 showed another steady reduction of CP6. CP9 had a larger shade reduction (scores of 2-5) from Day 1 to Day 4, followed by a steady reduction until Day 14. Spectrometer analysis shows that CP9 samples had lower absorbance unit compared to CP6 samples for both second-day and sixth-day groups. However, most changes can be observed on the CP9 samples from control to the second-day and sixth-day. Conclusion: Bleaching agent with low concentration can approach the efficacy of high concentration of bleaching agent with an extended treatment time.

Excessive salt intake has been linked to the development of hypertension and non-communicable diseases. This study aims to explore the different types of salt reduction intervention implemented among adults aged ≥18 years and to identify the suitable settings, duration and tools used for effective salt reduction interventions. This review adapted the established structured scoping review framework by Arksey and O’Malley. Related articles from the year 2008 to 2018 were retrieved based on the study objectives using keywords in electronic databases and through a bibliographic search of books, reports, conference proceedings, posters and summaries. Out of 130 potentially relevant full-text articles assessed, 14 articles were included in the review. Suitable salt reduction initiatives for the community who regularly consume home-cooked food are through cooking and usage of a tool such as a salt-restriction spoon, together with awareness on the benefits of salt reduction in their daily diet. Healthy catering initiative should be implemented in the workplace or institution-based settings. Policy development targeting the source of salts such as mandatory usage of salt-substitutes or Front-of-Pack labelling of salt content in all food products suitable for population-level intervention.