KNOWLEDGE AND SELF-EFFICACY ON EXCLUSIVE BREASTFEEDING AMONG WORKING WOMEN IN JERANTUT, PAHANG Providing essential nutrients to support healthy growth and development in young infants is commonly achieved through breastfeeding, a traditional means of nourishment. In Malaysia, even though more awareness campaigns on the benefits of exclusive breastfeeding (EBF) remain low than the rate recommended by WHO. This study was done to determine level of knowledge and self–efficacy on exclusive breastfeeding among working women in Jerantut. A cross-sectional study was conducted among the community of working women in Mukim Pedah with the involvement of 375 respondents by convenient sampling. A questionnaire was used to collect data on the respondents' sociodemographic characteristics, breastfeeding knowledge and Breastfeeding Self-Efficacy Scale – Short Form (BSES-SF). 93.1% of respondents had high level knowledge of exclusive breastfeeding, and high level of self-efficacy (83.7%). There was a statistically significant association between breastfeeding education with knowledge level in exclusive breastfeeding (p <0.05). There was a statistically significant association between age, education level, parity, breastfeeding education and experience in breastfeeding with self–efficacy (p<0.95). Exclusive breastfeeding benefits the health of both mother and child; having good knowledge and confidence in EBF may encourage mothers to breastfeed their babies for extended periods.

NATURAL PRODUCTS TARGETING NITRIC OXIDE AS A THERAPEUTIC STRATEGY FOR TREATMENT OF HYPERTENSION: A REVIEW Hypertension remains a significant global health challenge, necessitating the exploration of novel therapeutic strategies. Nitric oxide (NO) signaling plays a pivotal role in blood pressure regulation, making it an attractive target for hypertension management. Natural products have garnered considerable attention for their potential to modulate NO signaling pathways and mitigate hypertension. This review provides a comprehensive overview of natural products targeting NO as a therapeutic strategy for hypertension treatment. We systematically examine the mechanisms by which natural compounds enhance NO bioavailability, promote vasodilation, and exert antihypertensive effects. Key natural products are evaluated for their efficacy in preclinical studies. Furthermore, we discuss the challenges and limitations associated with translating preclinical findings to clinical practice. Overall, this review highlights the promising role of natural products in modulating NO signaling pathways and offers insights into their potential as adjunctive therapies for hypertension management. Further research is warranted to elucidate the optimal dosing regimens, long-term effects, and potential drug interactions of natural compounds in diverse patient populations.

ONLINE FOOD DELIVERY SERVICES USAGE AND ITS ASSOCIATED FACTORS AMONG A WORK POPULATION IN A MIDDLE INCOME COUNTRY, MALAYSIA Online food delivery services (OFDS) are popular due to its availability and convenience. However, OFDS with increasing food availability and choice, and decreasing barriers to food consumption effort may potentially lead to adverse health outcomes such as overweight/ obesity to the users, which is a public health challenge with increasing prevalence worldwide. Therefore, we aimed to determine the frequency and patterns of OFDS usage and its associated factors (socio-demographic characteristics, weight status and health literacy (HL)) among workers. This was a cross-sectional study conducted among civil servants in Peninsular Malaysia. Data collected were socio-demographic characteristics, body mass index (BMI), levels of HL, frequency and patterns of OFDS usage. There were 656 participants with a mean age of 39 (± 6.9) years who were mostly Malays (79.4%) and females (76.4%). The average frequency of OFDS usage was seven times a month with local food being the most frequently ordered type of food (50.3%). Furthermore, coffee and sugar-sweetened beverages (SSBs) were the common types of drinks frequently ordered along with meals. Price was the most important factor (92%) when making food choices. Factors associated with frequent OFDS usage were Malay ethnicity (aOR: 1.78; 95% CI: 1.16, 2.73), high monthly household income (aOR: 2.71, 95% CI: 1.48, 4.97) and age, where the younger the age group, the higher the adjusted odds ratio for its use when compared to the oldest age group. However, there were no associations between frequent OFDS usage with overweight/ obesity and low HL levels. Besides, education levels and occupation were also not associated with frequent OFDS usage. This study contributes to limited studies on OFDS usage and its associated factors among the adult population in Malaysia. Future research could be carried out to explore the association of sociodemography, HL and body mass index among a more diverse Malaysian population.

INNOVATIVE NANOPARTICLE DELIVERY OF TEA POLYPHENOLS FOR ENHANCED COLORECTAL CANCER THERAPY Tea polyphenols have demonstrated potential in the prevention and treatment of colorectal cancer. However, its use in clinical settings has been hampered by drawbacks in terms of stability and bioavailability. This review aims to explore and evaluate the potential of nanoparticles as efficient delivery vehicles for tea polyphenols in the context of colorectal cancer therapy. In this review, we summarize studies on the efficacy of tea polyphenols on colorectal cancer and their limitations for colorectal cancer therapy. Moreover, we also discuss the mechanistic signalling pathway of tea polyphenols and how nanotechnology improves the limitations. Furthermore, the mechanisms performed using nanoparticles in drug delivery and the significance of nanoparticles for targeted drug delivery were covered in this review. The future of colorectal cancer therapy may be significantly influenced by the integration of nanotechnology to deliver tea polyphenols. Nanoparticle-based delivery systems promise to overcome inherent challenges associated with the bioavailability and targeted delivery of tea polyphenols. By enhancing solubility, stability, and controlled release, nanotechnology can optimise the therapeutic efficacy of these bioactive compounds.

A CONCEPTUAL MODEL OF FRAILTY IN OLDER ADULTS: A LITERATURE REVIEW This review employed several key procedures to synthesize the current evidence on frailty. An extensive literature search was conducted across major databases to identify relevant studies on frailty definitions, epidemiology, assessment tools, interventions, and conceptual models. The search results were analyzed using bibliometric techniques including thematic mapping with Biblioshiny and co-occurrence network visualization with VOSviewer. These bibliometric analyses identified core research themes, emerging topic clusters, and connections across the frailty literature. The main findings highlighted frailty's multidimensional nature spanning physical, cognitive, psychological, and social domains. While the frailty phenotype by Fried et al. (2) provided an initial operational definition, subsequent models increasingly encompassed a broader biopsychosocial frailty construct. Globally, over 10% of community-dwelling older adults were estimated as frail, with rates exceeding 40% in those over 90 years old. Frailty was associated with numerous adverse outcomes like disability, falls, hospitalization and mortality. Current assessment approaches included the frailty phenotype, frailty index, and various clinical performance tests, though no single comprehensive tool existed. Evidence supported tailoring multimodal interventions combining physical, nutritional, cognitive, psychological and social strategies to individual risk profiles. The principal conclusion was the critical need for a unified, holistic conceptual model elucidating the complex interplay of factors driving frailty's development and progression. Integrating the findings, a biopsychosocial framework was proposed conceptualizing frailty as a multifactorial health state arising from the cumulative impact of interconnected physical, cognitive, psychological, social and environmental determinants over the life course. Such models are essential for advancing frailty science, shaping clinical practices, and informing policies to promote healthy, resilient aging amid rapidly aging populations worldwide.

EFFECTIVENESS OF DIABETES SELF-MANAGEMENT EDUCATION (DSME) AND FAMILY-BASED INTERVENTIONS ON QUALITY OF LIFE IN PEOPLE WITH TYPE 2 DIABETES Diabetes is a health condition that can have a significant impact on quality of life. Therefore, self-care management and family support may be important in helping people with diabetes maintain or improve their quality of life. The purpose of this study was to evaluate the effectiveness of the Diabetes Self-Management Education (DSME) program and family-based interventions in improving the quality of life of people with type 2 diabetes. This research was conducted using a quasi-experimental design with a one-group pre- and post-test. A sample of 54 individuals was selected using purposive sampling technique. Analysis was performed using dependent and independent t-tests. The results indicated that the DSME program was effective in improving quality of life in all domains (p < 0.05). Family-based interventions were shown to improve quality of life (p = 0.045) and psychological (p = 0.010) and environmental (p = 0.029) domains. However, the two interventions did not appear to differ in improving quality of life (ppre = 0.727; ppost = 0.466). The study concluded that DSME and family-based interventions are effective in improving quality of life in people with type 2 diabetes. These interventions can be implemented in other health care settings.

LIGNOCAINE INFUSION FOR NEUROPATHIC ITCH IN PATIENT WITH NEUROFIBROMATOSIS Neurofibromatosis (NF) is an autosomal dominant neurocutaneous disorder. The itchiness suffered by patients with NF is possibly caused by mast cells. However, transient receptor potential ankyrin 1 (TrpA1) and transient receptor potential vanilloid 1 (TrpV1) have been recently discovered as mediators of itchiness and pain in patients with NF. We reported a patient with NF, afflicted by neuropathic pain and itch, despite despite receiving conservative treatment. Herein, we provided the patient lignocaine infusion, which improved her pain and itch score by 50%. Additionally, her sleep quality, ability to perform housework and engagement in leisure activities were improved. This case report highlights the therapeutic value of lignocaine infusion when conservative treatment is ineffective for chronic neuropathic itch in patients with neurofibromatosis through suppressing TrpA1 and TrpV1.

OLIGOSACCHARIDES IN MILK: EXPLORING NOVEL ANTIFUNGAL PROPERTIES AGAINST CANDIDA ALBICANS AND CANDIDA KRUSEI With the increasing antifungal resistance and prevalence of candidiasis, the aim of this research is to evaluate the potential inhibitory effects and synergistic activities of oligosaccharides present in milk with azoles in inhibiting the growth of Candida albicans and Candida krusei. The oligosaccharides were derived from breast milk (OH), bovine (OB), goat (OG), and formula milk (OF), then confirmed by thin-layer chromatography (TLC). Disk diffusion and microdilution were used to evaluate the antifungal potency of oligosaccharides using disk diffusion and microdilution. The oligosaccharides only showed antifungal activity in microdilution. The statistical analysis showed moderate variability in minimum inhibitory concentration (MIC) values and higher fractional inhibitory concentration (FIC) values. A significantly wide range of MIC in the microdilution assay indicated the effectiveness of this antifungal agent varied across different samples. In the combination test, antagonistic activity was observed between fluconazole and oligosaccharides against C. albicans ATCC 90028. Further research is needed to study the mechanisms of antifungal activity and synergism between oligosaccharides and azoles against Candida species.

BRASH SYNDROME – A RARE CAUSE OF BRADYCARDIA WITH RENAL FAILURE The BRASH syndrome is a rare clinical pentad characterised by bradycardia, renal failure, atrioventricular (AV) blockade, shock and hyperkalaemia. Patients with BRASH syndrome typically present with bradycardia and hypotension due to the synergistic effect of AV node blocker and hyperkalaemia, compounded by underlying renal failure. In this report, we present a young patient with a history of chronic kidney disease and hypertension, who was taking regular beta-blockers and calcium channel blockers, and presented with persistent dizziness, headache and lethargy, which progressed into bradycardia and shock. These symptoms were refractory to initial resuscitation, requiring inotropic support and urgent haemodialysis. The patient was discharged in good condition after initiating regular dialysis. A high index of suspicion and early recognition are key to managing BRASH syndrome. Standard advanced cardiac life support algorithms without calcium are generally impractical for BRASH syndrome. The prognosis for BRASH syndrome is excellent with timely recognition and management.

A SINGLE CENTRE STUDY ON PREVALENCE AND PREDICTIVE FACTORS FOR INCIDENTAL PROSTATE CANCER FOLLOWING TRANSURETHRAL RESECTION OF PROSTATE Background: Many prostate cancers remain undiagnosed until benign prostatic hyperplasia (BPH) surgeries are performed. Transurethral resection of the prostate (TURP) renders subsequent radical prostatectomy technically challenging. Therefore, it is advantageous to identify high-risk patients and consider further investigations prior to BPH surgery. Objectives: This study aims to report the prevalence of incidental prostate cancer (IPC) following TURP at Penang General Hospital and to develop predictive factors for IPC. Methods: This retrospective observational study reviewed patients who underwent TURP for presumed BPH over the past five years. Clinicopathological variables studied included patient age, serum prostate-specific antigen (PSA) level, prostate volume, PSA density, resected prostatic tissue weight, and histopathological assessment of the resected specimen. Results: A total of 220 patients underwent TURP for presumed BPH from April 2018 to April 2023. Thirteen patients (5.9%) had IPC, including seven patients with T1a disease and six patients with T1b disease. The most common cancer detected was ISUP grade group 1 (n = 6), followed by grade groups 2 (n = 4), 3 (n = 2), and 4 (n = 1). Stepwise binary logistic regression analysis revealed that a PSA density of >0.15 ng/ml² (p = 0.001) and low resected prostatic tissue weight (p = 0.024) correlated with an increased prevalence of IPC, with odds ratios of 26.1 and 0.9, respectively. Conclusions: The prevalence of IPC at Penang General Hospital is 5.9%. A PSA density of >0.15 ng/ml² and low resected prostate volume are associated with a higher risk of IPC following TURP. Patients at risk should be offered further investigations, such as mpMRI of the prostate and/or repeat prostatic needle biopsy prior to BPH surgeries. Additionally, pathologists should consider examining the specimens of at-risk patients in their entirety rather than using standard handling procedures.