Background: In our country, the high prevalence of chronic liver diseases is influenced by factors such as hepatotoxic viruses, excessive alcohol and drug consumption, and a high incidence of obesity among the population. Although the point at which liver fibrosis becomes irreversible remains unclear, some researchers have suggested, based on clinical studies, that fibrosis may still be reversible in the early stages of cirrhosis. Aim: Therefore, in this study, we aimed to evaluate the degree of liver fibrosis using key markers involved in the pathogenesis of hepatic scarring—MMP-1 (matrix metalloproteinase-1), MMP-2 (matrix metalloproteinase-2), and PIIINP (N-terminal propeptide of type III procollagen)—as well as non-invasive serum markers of hepatocyte injury (APRI and FIB-4), and to compare these findings with the results of liver biopsy. Materials and Methods: This analytical case-control study included 50 patients in the State Third Central Hospital. Peripheral blood samples were analyzed for platelet count, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) using a fully automated analyzer, while serum direct markers were measured using ELISA. Non-invasive serum markers (APRI and FIB-4) were calculated using the MD+CALC online system. Liver tissue for histological examination was obtained via biopsy, and the degree of liver fibrosis was assessed according to the METAVIR scoring system. Differences in mean values of quantitative variables between two groups were analyzed using the Mann-Whitney U test was applied. The correlation between METAVIR stages and serum markers was evaluated using Spearman’s correlation. Results: Among the study participants, according to the METAVIR classification, 15 individuals (30%) had no or minimal fibrosis (F0–F1), 26 individuals (52%) had significant fibrosis without cirrhosis (F2–F3), and 9 individuals (18%) had cirrhosis (F4). As the stage of fibrosis increased, the mean levels of AST (r=0.326, p=0.021), ALT (r=0.392, p=0.005), MMP-2 (r=0.393, p=0.005), PIIINP (r=0.472, p=0.001), as well as APRI (r=0.503, p<0.001) and FIB-4 (r=0.482, p<0.001) showed an increasing trend. In contrast, mean platelet count (r=–0.507, p<0.001) and MMP-1 (r=–0.383, p=0.006) decreased with advancing fibrosis stages. Using AUC-ROC analysis to assess the diagnostic performance of both direct and indirect serum markers, the ability to detect significant fibrosis and cirrhosis was estimated as follows: APRI 80%, FIB-4 75%, MMP-1 67.1%, MMP-2 72.2%, and PIIINP 72.3%. Conclusion In our study, the diagnostic performance of both direct and indirect serum markers for predicting liver fibrosis exceeded 65%. Mean levels of AST, ALT, MMP-2, PIIINP, APRI, and FIB-4 increased with advancing fibrosis stages, whereas mean platelet counts and MMP-1 levels decreased.

Aphasia assessment is crucial in diagnosing aphasia, determining the extent of language impairment, and identifying factors that may support or restrict aphasia recovery to design an appropriate plan of care for people with aphasia. Speech-language therapists (SLTs) play a major role in conducting aphasia assessments. Little is known about the practices of SLTs in assessing aphasia in low-resource regions. The present study aims to identify aphasia assessment practices among Malaysian SLTs and related challenges, as well as strategies for improving aphasia assessments from SLTs’ perspectives. A total of 32 SLT participants who have been practicing in Malaysia completed an online survey to gather their background information, data pertaining to practices and challenges in conducting aphasia assessments, and suggestions for improving aphasia assessments. Descriptive analyses were conducted for all numerical data. Suggestions for improving aphasia assessment practices were analysed qualitatively using the thematic content analysis approach. SLT practices in aphasia assessment were found to be consistent in certain aspects, but not all. Two major challenges were identified: (a) linguistic barriers between clinicians and clients/caregivers, and (b) a lack of standardized assessment tools for aphasia evaluations. Participants suggested “Internal Strategies” and “External Strategies” for improving aphasia assessment practices.

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.

Children with disability require comprehensive and continuous rehabilitation. Community-based rehabilitation (CBR) was developed to fulfil this need and has benefited children of various ages both in the rural and urban societies. In Malaysia, the government largely fund rehabilitation of children at the CBR centers. However, to date research data on the outcome of CBR on children with disability in the country is scarce. This study was intended to determine the outcome of CBR and its associated factors among children with disability. Outcome of rehabilitation was determined with regard to changes in activity of daily living ability with the use of the Barthel Index at 6 months post-CBR. Analysed factors were age, baseline score of the Barthel Index, frequency of attendance in therapy sessions and number of therapy received. Data was analysed using paired t test, Wilcoxon signed ranks test and Spearman correlation test. A total of 220 children with disability aged 4 to 18 years and 220 caretakers from 29 selected CBR centres in Pahang, Terengganu and Kelantan participated in this study. The results showed a small increase in the Barthel Index score of the children, with mean change ± SD equals 0.90 ± 4.54 (p=0.003) following rehabilitation. Attendance to therapy sessions was low, with <50% attended three quarter or more sessions of the total sessions offered. No analysed factors were found to be associated with the change in the Barthel Index (p>0.05). As a conclusion, the outcome gained through CBR is too small for the duration of rehabilitation implemented. The delivery of CBR program need to be reviewed and enhanced to improve its effectiveness on children with disability.

Homocystineimia is an Inborn Errors of Metabolism (IEM) which can occur due to accumulation of homocysteine. Homocysteine is one of the sulfur-containing amino acid with thiol group that is formed by demethylation of methionine. Deficiency of enzymes involves in homocysteine metabolism can give rise to seven types of homocystinemia subject to total homocysteine level. Therefore reference ranges are needed to differentiate between normal and abnormal population as well as the type of homocystineimia depending on the enzymes defect in the pathway. Hence, homocysteine reference ranges in children for the Malaysian population were postulated. 3 mL of blood was collected from 86 normal individuals (52 boys and 34 girls) and then subsequently processed and analysed using High Performance Liquid Chromatogrphy – Ion Exchange Chromatography (HPLC-IEC). The calculated mean total homocysteine for the population was 8.1 ± 3.89 µM (95% confidence interval, l 7.3-8.9 µM). Reference range was 2.5 – 16.2 µM with lower and upper cut-off were 1.0 µM dan 21.0 µM, respectively. The newly developed reference range of total homocysteine for Malaysian children is able to reduce false negative cases in the laboratory.

Falls is one of the main problems in older adults, which indirectly contributes to deterioration of quality of life, morbidityand mortality. The purpose of this study was to examine the difference in values between Timed Up and Go (TUG) andgait speed tests among community dwelling older adults with high and low risk of falls classified using PPA (PhysiologicalProfile Assessment). This cross-sectional study involved 278 older adults aged between 60 to 88 years, recruited fromsenior citizen club around Klang Valley. 40.6% older adults had high risk of falls and mostly were women (75%). Theresults of the study showed that there was a significant (p < 0.05) difference in TUG and Gait speed tests performancebetween older adults with high and low risk of falls. Declined mobility (longer time of TUG test) and increased age wereidentified as significant (p < 0.05) risk factors for falls in this study. The TUG test reference values obtained in this studymay be useful for early identification, prevention and management of falls among community dwelling older adults.

OBJECTIVEThe present study was designed to investigate the effects of subchronic low level microwave radiation (MWR) on cognitive function, heat shock protein 70 (HSP70) level and DNA damage in brain of Fischer rats.

METHODSExperiments were performed on male Fischer rats exposed to microwave radiation for 90 days at three different frequencies: 900, 1800, and 2450 MHz. Animals were divided into 4 groups: Group I: Sham exposed, Group II: animals exposed to microwave radiation at 900 MHz and specific absorption rate (SAR) 5.953 × 10-4 W/kg, Group III: animals exposed to 1800 MHz at SAR 5.835 × 10-4 W/kg and Group IV: animals exposed to 2450 MHz at SAR 6.672 × 10-4 W/kg. All the animals were tested for cognitive function using elevated plus maze and Morris water maze at the end of the exposure period and subsequently sacrificed to collect brain tissues. HSP70 levels were estimated by ELISA and DNA damage was assessed using alkaline comet assay.

RESULTSMicrowave exposure at 900-2450 MHz with SAR values as mentioned above lead to decline in cognitive function, increase in HSP70 level and DNA damage in brain.

CONCLUSIONThe results of the present study suggest that low level microwave exposure at frequencies 900, 1800, and 2450 MHz may lead to hazardous effects on brain.

Animals ; Cognition ; radiation effects ; DNA Damage ; HSP70 Heat-Shock Proteins ; genetics ; Male ; Microwaves ; adverse effects ; Rats ; Rats, Inbred F344