Public interest in cognitive enhancement has driven the widespread availability of dietary supplements claiming to support brain health and memory. This comparative cross-sectional study explores the commercial availability and marketing claims of cognitive-enhancing dietary supplements across offline and online retail platforms. A dual-component design was employed in a comparative cross-sectional study. The first component involved assessing the commercial availability and marketing claims of cognitive-enhancing dietary supplements sold through offline retail outlets in Kuala Lumpur using a purposive sampling approach. The second component consisted of a parallel assessment conducted on online platforms, employing a convenience sampling strategy. A total of 13 products were identified on offline retail platforms in Kuala Lumpur, and 117 products were identified on online platforms. Capsules were the most common dosage form, both offline (46.2%) and online (79.5%). Products sold offline most frequently originated from Singapore (69.2%), whereas online products predominantly came from the United States of America (74.4%). The median prices of offline products were RM 190 (55.5), and online products were RM 196 (183), which are comparable, although the online products exhibited a wider price range (RM14–RM1,147). The most frequent claims were “brain health” for offline products and “memory” for online products. Natural or compound extracts were the most common active ingredients. This study’s findings found significant differences between offline and online dietary supplements in terms of availability, country of origin, price and marketing claims. These inconsistent findings underscore the need for stronger regulation and improved transparency in labelling to safeguard consumer health and ensure product credibility. Future research should focus on dosage accuracy, long-term safety, and mechanisms of action for supplements with cognitiveenhancing claims.

INTRODUCTION: Cancer patients attending emergency departments (EDs) often present with acute symptoms and are frequently admitted. This study aimed to characterise the profile of oncology patients who were discharged from the ED. METHODS: This was a retrospective audit of patients with cancer-related diagnoses who presented to the ED at the Singapore General Hospital (SGH) over a 6-month period from 1 October 2018 to 31 March 2019 and were directly discharged from the ED. Data was extracted from the hospital's electronic medical record system. RESULTS: Of the 492 participants included in the study, the majority were triaged as Priority 2 (61.4%), while 30.7% were triaged as Priority 3, 6.9% as Priority 1 and 1.0% as Priority 4. There was no statistical difference between the National Early Warning scores across the different triage categories in these patients. The most common complaint was (44.3%), followed by genitourinary symptoms (19.5%) and those related to devices, catheters or stomas (17.3%). More investigations of all types were done for patients being managed in Priority 1 (57.6%) than in the other triage categories (40.1% for Priority 2, 23.2% for Priority 3 and 12.0% for Priority 4). Treatment procedures carried out were mainly symptomatic (analgesics, antiemetics, proton pump inhibitors) for 79.8% of the patients. There were no significant differences in the proportion of patients requiring various treatment modalities among the triage categories. CONCLUSION Selected oncological patients may potentially be managed in an ambulatory setting.
Humans ; Emergency Service, Hospital/statistics & numerical data* ; Retrospective Studies ; Female ; Neoplasms/diagnosis* ; Male ; Singapore ; Patient Discharge/statistics & numerical data* ; Middle Aged ; Aged ; Triage ; Adult ; Emergencies ; Aged, 80 and over

BACKGROUND: According to the amyloid, tau, neurodegeneration research framework classification, amyloid and tau positive (A+T+) mild cognitive impairment (MCI) individuals are defined as prodromal Alzheimer disease. This study was designed to compare the clinical and biomarker features between A+T+MCI individuals who progressed to progressive MCI (pMCI) and those who remained stable MCI (sMCI), and to identify relevant baseline clinical biomarker and features that could be used to predict progression to dementia within 2 years. METHODS: We stratified 197 A+T+MCI individuals into pMCI (n = 64) and sMCI (n = 133) over 2 years. Demographics and cognitive assessment scores, cerebrospinal fluid (CSF), and neuroimaging biomarkers (18F-florbetapir positron emission tomography mean standardized uptake value ratios [SUVR] and structural magnetic resonance imaging [MRI]) were compared between pMCI and sMCI at baseline, 12- and 24-month follow-up. Logistic regression models then were used to evaluate clinical baseline and biomarker features that predicted dementia progression in A+T+MCI. RESULTS: pMCI individuals had higher mean 18F-florbetapir SUVR, CSF total-tau (t-tau), and p-tau181P than those in sMCI individuals. pMCI individuals performed poorer in cognitive assessments, both global and domain specific (memory, executive, language, attention, and visuospatial skills) than sMCI. At baseline, there were significant differences in regions of interest of structural MRI between the two groups, including bilateral amygdala, hippocampus and entorhinal, bilateral inferior lateral ventricle, left superior and middle temporal, left posterior and caudal anterior cingulate (P < 0.05). Baseline CSF t-tau levels and cognitive scores of Montreal cognitive assessment, functional assessment questionnaire, and everyday cognition by the patient's study partner language domain could predict progression to dementia in A+T+MCI within 2 years. CONCLUSIONS In future clinical trials, specific CSF and cognitive measures that predict dementia progression in A+T+MCI might be useful risk factors for assessing the risk of dementia progression.
Alzheimer Disease ; Amyloid beta-Peptides ; Biomarkers ; Cognitive Dysfunction ; Disease Progression ; Humans ; Peptide Fragments ; Positron-Emission Tomography

Background: Managing potential COVID-19 patients is challenging when resources were limited. The objective of this study was to evaluate the predictive parameters and management strategy for potential COVID-19 cases who are without contact or travelling history. Methods: Retrospective study of potential COVID-19 patients without direct contact or travelling history, admitted to Hospital Tuanku Ja’afar Seremban. Patients were riskstratified to either low or medium risk and admitted to designated wards, respectively. They were categorised to severe acute respiratory infection (SARI); influenzalike illness (ILI); dengue fever or viral fever like (DVF); or none. Clinical, laboratory and radiological variables were evaluated for predictive value. Positive cases were isolated to negative pressure isolation rooms and the neighbouring patients underwent surveillance. Results: 812 patients were studied, with 478 fulfilled SARI, ILI, and DVF. 18 (2.2%) of them were COVID-19 positive, and all patients in “none” group were negative. Hypoxia without dyspnoea and medium risk criteria were significant in predicting COVID-19 with p<0.01 (OR 7.18; 95% CI 2.70, 19.13) and p<0.01 (OR 35.77; 95% CI 11.25, 113.71) respectively. Absolute lymphocyte count showed no predictive value (P=0.88 95% CI -0.78, 0.90). Absolute neutrophil count ≥10 x10^9/L cells (OR 0.11; 95% CI 0.01, 0.87) helped to exclude COVID-19. Chest radiograph of 16 (88.9%) COVID-19 patients showed heterogeneous Ill-defined opacities. No nosocomial transmission occurred during this study period. Conclusion / Implication Initial attention to predictive parameter, riskstratification, clinical grouping strategy, and proper ward management helps in containment of COVID-19 and resources management without risk of nosocomial transmission.
COVID-19 ; SARS-CoV-2

Objective:To investigate the predictive value of serumal retinol-binding protein 4(RBP4) level fro fetal macrosomia of non-diabetic pregnant women .Methods :The serumal levels of RBP4 of 500 non-diabetic pregnant women at 12 week ,20 week and 24 week of pregnancy were measured by immune projection turbidimetric method .Fetal macrosomia was defined as birth weight≥4000 g .The cut-off value ,sensitivity and specificity were calculated with receiver operating characteristic (ROC) curve .Results:Of the 500 non-diabetic pregnant women ,30 cases(6% ) got fetal macrosomia .The ROC curve showed that the predictive cut-off values of RBP4 at 12 week ,20 week and 24 week of pregnancy were 61 .0 mg/L ,50 .5 mg/L and 52 .5 mg/L , respectively ;the predictive sensitivity and specificity at 12 week ,20 week and 24 week of pregnancy were 42 .9% and 94 .5% , 70 .0% and 69 .5% ,76 .9% and 73 .2% ,respectively .The predictive cut-off value of RBP4 no later than 24 week of pregnancy was 51 .5 mg/L ;the predictive sensitivity and specificity were 61 .8% and 69 .5% .There was significant difference(P<0 .05) between the serumal level of RBP4 at 24 week of pregnancy in group fetal macrosomia and that in group nonfetal macrosomia . Conclusions :The predictive sensitivity of RBP4 increases in accordance with the increase of serumal level of RBP 4 .The serumal level of RBP4 of non-diabetic pregnant women at 24 week of pregnancy may have higher sensitivity and specificity in the predic-tion of fetal macrosomia .If the serumal level of RBP4 no later than 24 week of pregnancy is beyond 50 mg/L ,then the risk of fetal macrosomia will be higher .

Objective To study the correlations between O (6) -methylguanine-DNA-methyltransferase (MGMT) gene promoter methylation status in malignant glioma tissues and both MGMT protein expression and survival prognosis in these patients, and evaluate the significance of MGMT gene methylation status analyzing with methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) method in chemotherapy of brain glioma.Methods Thirty-nine patients with gliomas confirmed by pathology (WHO grade Ⅲ and grade Ⅳ)were collected in our study; the patient's overall survival (OS) after chemotherapy was tracked.MGMT protein expression of glioma tissues was detected by immunohistochemical staining,and MGMT promoter methylation status was detected by MS-MLPA method. Results Statistical difference of OS time was noted between patients with MGMT-negative and patients with MGMT-positive/-weak-positive (P=0.003).The prognosis in patients with positive MGMT protein expression was obviously poorer than that in patients with negative expression. In the groups of MGMT promoter un-methylation, mild hypermethylation, moderate hypermethylation and extensive hypermethylation, significant statistical difference of OS time was noted between each 2 groups (P＜0.05); the higher degree of methylation,the better prognosis. Statistical correlation was noted between MGMT protein expression and promoter methylation status (r=0.697,P=0.000); the higher degree ofmethylation,the lower protein exression of MGMT. Conclusion Both MGMT protein expression and promoter methylation status can be regarded as prognostic indicator of OS in patients with malignant glioma accepted alkylating agent chemotherapy; MS-MLPA is a reliable method to detect MGMT gene promoter methylation status.

OBJECTIVETo evaluate the serological markers and biological marker in the diagnosis of hepatitis E infection in a rhesus monkey model.

METHODS86 rhesus monkeys had been infected with different doses of HEV. Hence, they were taken sequential blood samples at intervals up to 86 weeks for 4 hepatitis E virus (HEV) specific antibody assays (E2-IgM, E2-IgG, GL-IgG, and YES-IgG), and nucleic acid assay.

RESULTSAll the animals produced E2-IgG and all but one also produced E2-IgM and excreted the virus in stool, whereas positive rate of GL-IgG and YES IgG were low and correlated with virus level. Hepatitis occurred over a period of 4 weeks (between 3 an 7 weeks) after infection. Virological marker occurred mainly during incubation period and declined rapidly after onset of hepatitis. Seroconversion of E2-IgM occurred before onset of hepatitis in 70% monkeys and declined rapidly up to 50% of peak value after 4 weeks. E2-IgM seroconversion was closely paralleled by E2-IgG; however, E2-IgG persisted in all animals for the entire duration of experiment of up to 86 weeks. Production of GL-IgG and YES-IgG was delayed by one week after the E2 antibodies, these antibodies showed a transient occurrence and seroprevalence declined to 50% of the peak value over a period of 12 weeks.

CONCLUSIONE2-IgM might be used as a suitable acute hepatitis E marker, and E2-IgG as a suitable epidemiological marker. The seroconversion or titer elevation of GL-IgG and YES-IgG antibodies probably used to confirm the infection. The viral markers are optional for early diagnosis.

Alanine Transaminase ; blood ; Animals ; Biomarkers ; Genotype ; Hepatitis Antibodies ; blood ; Hepatitis E ; diagnosis ; Hepatitis E virus ; classification ; genetics ; immunology ; Immunoglobulin E ; blood ; Immunoglobulin M ; blood ; Macaca mulatta