Cost-Effectiveness of Mobile Application Use in Managing Type 2 Diabetes Mellitus: A Systematic Review Introduction Type 2 diabetes mellitus (T2DM) is a debilitating condition that imposes a significant economic burden on its management. This study aims to systematically review the published evidence on the cost-effectiveness of mobile health (mHealth) application interventions for T2DM. Methods A search strategy was conducted using electronic bibliographic databases, including PubMed, Web of Science and Scopus for published studies. The inclusion criteria included original articles that reporting cost-effectiveness evaluation studies on mHealth application interventions directed at patients diagnosed or at risk of T2DM, English-language articles and published in the year 2016 to 2020. Results A total of 6 eligible studies were selected. The cost savings per person for treating T2DM ranged from USD 1,346 to USD 3,781 per year. The major contributor to cost savings was reduced complication management resulting from good glycaemic control. The direct impacts of the intervention include reduced hospitalisation and fewer unplanned clinic visits, while diabetes- related mortality was indirectly reduced usingmHealth. Conclusions The mHealth intervention was cost-effective in managing patients with T2DM. Implementation can be extended to other disease management areas to not only reduce total healthcare expenditure but also improve patients’ quality of life.

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours commonly found in the gastrointestinal tract, particularly in the stomach, but they can mimic gynaecological tumours. We report the case of a 56 -year-old postmenopausal woman who presented with a right adnexal pelvic mass. Computed tomography (CT) revealed a large, lobulated pelvic mass with liver lesions. Pan - endoscopy showed normal findings, and her tumour markers were within normal limits. Based on these findings, the gynaecological oncology team proceeded with a laparotomy and tumour debulking, diagnosing the pelvic mass as likely ovarian in origin. Intraoperatively, the mass was found to originate from the stomach and extend posteriorly to the transverse colon. An en -bloc resection with primary anastomosis was performed and histopathology confirmed a high -risk GIST. The patient made a good post -operative recovery and was scheduled for adjuvant chemotherapy at her follow -up visit. This case highlights the importance of considering GIST as a differential diagnosis in postmenopausal women presenting with an abdominopelvic mass that may mimic an ovarian tumour

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours commonly found in the gastrointestinal tract, particularly in the stomach, but they can mimic gynaecological tumours. We report the case of a 56 -year-old postmenopausal woman who presented with a right adnexal pelvic mass. Computed tomography (CT) revealed a large, lobulated pelvic mass with liver lesions. Pan - endoscopy showed normal findings, and her tumour markers were within normal limits. Based on these findings, the gynaecological oncology team proceeded with a laparotomy and tumour debulking, diagnosing the pelvic mass as likely ovarian in origin. Intraoperatively, the mass was found to originate from the stomach and extend posteriorly to the transverse colon. An en -bloc resection with primary anastomosis was performed and histopathology confirmed a high -risk GIST. The patient made a good post -operative recovery and was scheduled for adjuvant chemotherapy at her follow -up visit. This case highlights the importance of considering GIST as a differential diagnosis in postmenopausal women presenting with an abdominopelvic mass that may mimic an ovarian tumour

Environmental Determinants in Sustaining the Transmission of Lymphatic Filariasis: A Systematic Review IntroductionSince mass drug administration continues in many of the endemic countries, it is vital to synthesise evidence to adapt the challenges contributed by the environments. As such, the aim of this review was to explore relationship between lymphatic filariasis prevalence and potential environmental determinants .MethodsWe searched the electronic databases PubMed, Web of Science, Cochrane, and Scopus between Jan 1, 2013, and Dec 31, 2022, for studies fulfilling the following criteria: it was an original article investigating the environmental determinants associated with transmission of lymphatic filariasis; and the study was published in English. The quality assessment tools for observational studies from the National Heart, Lung, and Blood Institute was used to assess the study quality. This systematic review was registered with the PROSPERO database (CRD42023393018).ResultsWe identified 409 potentially eligible published articles, of which 11 met our inclusion criteria. The main environmental determinants associated with lymphatic filariasis transmission were Normalised Difference Vegetation Index (NDVI), land cover, distance to waterbody, rainfall/precipitation, elevation, slope, day land surface temperature, average annual temperature, house type and distance to stable light. ConclusionsThis review is one of the steps towards understanding the associations between environmental determinantsand transmission of lymphatic filariasis. These results can be used in future evidence-based strategies to strengthen surveillance and control strategies.

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: SABINA III assessed short-acting β2-agonist (SABA) prescription patterns and their association with asthma-related outcomes globally. Herein, we examined SABA prescription and clinical outcomes in the Malaysian cohort of SABINA III. Methods: In this observational, cross-sectional study, patients (≥12 years) were recruited between July and December 2019 from 15 primary and specialty care centres in Malaysia. Prescribed asthma treatments and severe exacerbation history within 12 months prior and asthma symptom control during the study visit were evaluated. Associations of SABA prescription with asthma control and severe exacerbation were analysed using multivariable regression models. Results: Seven hundred thirty-one patients (primary care, n=265 [36.3%]; specialty care, n=466 [63.7%]) were evaluated. The prevalence of SABA over-prescription (≥3 SABA prescriptions/year) was 47.4% (primary care, 47.1%; specialty care, 47.6%), 51.8% and 44.5% among all patients and patients with mild and moderate-to-severe asthma, respectively. Altogether 9.0% (n=66) purchased SABA without a prescription; among them, 43.9% (n=29) purchased ≥3 inhalers. The mean (standard deviation) number of severe asthma exacerbations was 1.38 (2.76), and 19.7% (n=144) and 25.7% (n=188) had uncontrolled and partly controlled symptoms, respectively. Prescriptions of ≥3 SABA inhalers (vs 1–2) were associated with lower odds of at least partly controlled asthma (odds ratio=0.42; 95% confidence interval [CI]=0.27–0.67) and higher odds of having severe exacerbation(s) (odds ratio=2.04; 95% CI=1.44–2.89). Conclusion The prevalence of SABA over-prescription in Malaysia is high, regardless of the prescriber type, emphasising the need for healthcare providers and policymakers to adopt latest evidence-based recommendations to address this public health concern.
Asthma ; Malaysia

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

To evaluate the neuropharmacological properties of Costus speciosus (C. speciosus) rhizome using different experimental mouse models. Methods: The anxiolytic effect was investigated by hole-board test, elevated plus maze and light/dark test, while central nervous system (CNS) depressant effect was evaluated by thiopental sodium-induced sleep test. Finally, antidepressant effect was evaluated by forced swimming test and tail suspension test. Results: In both elevated plus maze and hole board test, 400 mg/kg C. speciosus showed more significant CNS depressant effect than 1 mg/kg diazepam. Both 200 mg/kg and 400 mg/kg C. speciosus extract produced a significant dose-dependent decrease in onset of sleep. In forced swimming test, C. speciosus rhizome showed a decrease in duration of immobility in a dose-dependent manner. Imipramine (10 mg/kg) and C. speciosus extract at 400 mg/kg dose exhibited a significant reduction in duration of immobility in tail suspension test which provided additional evidence of antidepressant effect of C. speciosus rhizome. Conclusions: Our study indicates that C. speciosus rhizome possesses CNS depressant, anxiolytic and antidepressant-like activities. Further studies are warranted determine the exact phytoconstituents and mechanism of action responsible for the neuropharmacological effect.

Objective To establish a suitable method of diagnosis of visceral leishmaniasis (VL) using peripheral blood, spleen or bone marrow aspirates. Methods Peripheral blood, bone marrow and spleen aspirate samples were collected from clinically suspected VL patients (n = 26). A new PCR primer pair (MK1F/R) was designed targeting kinetoplast mini circle DNA sequences of Leishmania donovani, and Leishmania infantum, and was used to diagnose VL along with some other established primers for VL in polymerase chain reactions. Test was validated by comparing with several other diagnostic methods. Results The designed primer set showed 100% specificity and 98% sensitivity in detecting VL using blood samples, when compared with more invasive samples: bone marrow or spleen aspirates. Conclusions The newly designed primer MK1F/R could be a better alternative for PCR based diagnosis of VL using less invasive sample, peripheral blood instead of bone marrow or spleen aspirates.

Objective To investigate the effects of Andrographis paniculata (Burm.f.) Wall. Ex Nees (A. paniculata) on expressions and activities of catalase, superoxide dismutase and alkylhydroperoxide reductase C in Staphylococcus aureus (S. aureus) with respect to its survival in vitro. Methods Antioxidative property of methanolic leaves extract of A. paniculata (0.06 mg/mL). Minimum inhibitory concentration (MIC) was determined by its ability to reduce hydrogen peroxide (H