Objectives: The decision to withdraw treatment in patients with metastatic cancer is a complex and emotionally charged process influenced by multiple interrelated factors. Despite its significant clinical and ethical implications, this phenomenon remains insufficiently explored through qualitative inquiry. This study aimed to explore the factors influencing decisions to withdraw treatment among patients with metastatic cancer. Methods: A qualitative study using conventional content analysis was conducted. Fourteen patients with metastatic cancer were purposively selected. Data were collected through in-depth, semi-structured interviews and analyzed using the qualitative content analysis approach proposed by Graneheim and Lundman. Data organization was facilitated using MAXQDA software. Results: The analysis yielded 1 main theme (“Finding the meaning of life, and freedom from cycles of suffering”), 4 categories, and 15 subcategories. The overarching theme suggests that understanding life’s meaning enables patients to situate their illness within a broader existential purpose, thereby affirming life’s intrinsic value beyond mere physical survival. The 4 categories were social and family influences, physical health factors, psychological determinants, and divine and spiritual beliefs. Conclusions This study outlines a multilevel approach to improving end-of-life care. At the clinical level, holistic nursing assessments are needed to guide transitions to palliative care. At the institutional level, implementing structured protocols with multidisciplinary support and financial counselling is essential. At the national level, policies should ensure universal health coverage and promote cultural acceptance of dignified treatment withdrawal. These findings provide actionable insights for healthcare administrators and policymakers and offer a foundation for strategies aimed at reducing barriers and improving access to supportive care services.

Methods: In total, 185 lesions were identified on bone and SPECT-CT scans from 32 patients. Lesions were classified as metastatic (109 sclerotic lesions) and benign (76 lesions) morphologically on low-dose CT. Semiquantitative analysis using SUVmax and mean HU was performed on the lesions and compared. To discriminate benign and metastatic lesions, the correlation between SUVmax and mean HU was determined using the intraclass correlation coefficients. Results: The SUVmax was higher in metastatic lesions (20.66±14.36) but lower in benign lesions (10.18±12.79) (p<0.001). The mean HU was lower in metastatic lesions (166.62±202.02) but higher in benign lesions (517.65±192.8) (p<0.001). A weak negative correlation was found between the SUVmax and the mean HU for benign lesions, and a weak positive correlation was noted between the SUVmax and the mean HU on malignant lesions with no statistical significance (p=0.394 and 0.312, respectively). The cutoff values obtained were 10.8 for SUVmax (82.6% sensitivity and 84.2% specificity) and 240.86 for the mean HU (98.7% sensitivity and 88.1% specificity) in differentiating benign from malignant bone lesions. Conclusions Semiquantitative assessment using SUVmax and HU can complement qualitative analysis. Metastatic lesions had higher SUVmax but lower mean HU than benign lesions, whereas benign lesions demonstrated higher mean HU but lower SUVmax. A weak correlation was found between the SUVmax and the mean HU on malignant and benign lesions. Cutoff values of 10.8 for the SUVmax and 240.86 for the mean HU may differentiate bone metastases from benign lesions.

Malnutrition and poor quality of life (QoL) in older adults are becoming a public health concern. Therefore, this review article summarised significant studies which investigated the assessment of malnutrition and QoL and its relation. A literature research on academic journals published from 2011 to 2021 was conducted by using electronic databases, which were Google Scholar, PubMed, Science Direct and SCOPUS. A total of 21 studies with 26,569 participants were identified and included in this review. The prevalence of malnutrition ranged from 1.6% to 26.5%, and poor QoL was significant amongst malnourished older adults. In conclusion, malnutrition is associated with poor QoL amongst older adults. Future studies regarding factors that influence malnutrition and its relation towards the QoL amongst older adults are needed as it will help in assisting the healthcare professions to combat these health problems.

Introduction: Children with learning difficulties (LD) have poorer oral health compared to those without LD due to barriers in maintaining oral care. However, the scarcity of data for this population in Malaysia has left a huge gap in understanding their problems and how to overcome those barriers. Therefore, this study was conducted to evaluate the unmet dental needs and barriers to care perceived by the guardians of children with learning difficulties (CWLD) attending the Special Education Integrated Programmes of a mainstream primary school, in comparison to children without learning difficulties. Methods: This cross-sectional study surveyed the guardians of CWLD (case) and those without LD (control), aged 6-12 years old. A total of 225 questionnaires were distributed to the guardians with a response rate of 40.4% (N=91). Unmet dental needs and barriers in both groups were analysed using the chi-square test. Barriers with significant Chi-square results were further tested with logistic regression to investigate possible confounders. Results: Unmet dental needs of 23.1% of CWLD were found. Most of the guardians agreed that regular dental check-ups were the most needed dental treatment (27.1%) compared to other treatments. The child’s behaviour and the unwillingness of the dentists to treat were among the significant barriers to dental care within the CWLD group. Conclusion: Despite regular dental visits, guardians of CWLD perceived that their children had the most unmet dental needs compared to other children without LD, with significant barriers in terms of accessing professional dental services.

Introduction: COVID-19 is a disease caused by a new strain of coronavirus spreading rapidly over the globe, and the older population has had a larger impact as the fatality rate increases with age. This pandemic caused them to reduce their physical activity (PA). COVID-19 also resulted in food supply disruption and led to unhealthy dietary changes, which are usually associated with weight gain and affecting the body mass index (BMI). PA and BMI can influence the quality of life (QoL) of the older people. Therefore, this study aimed to determine the association between PA, BMI, and QoL amongst the older people in Malaysia during COVID-19. Methods: A cross-sectional study was conducted amongst community-dwelling older people from all states in Malaysia. An online survey consisting of self-reported anthropometry, Global Physical Activity Questionnaire- Malay version (GPAQ-M) and Short Form-36 Health (SF-36) Survey were collected. Statistical analysis chi-square test was used to identify the association between BMI, PA, and QoL. Results: This study included data from 180 individuals with a median age of 64.0 ± 9.8 years. The results showed that participants aged 60-69 years were significantly associated with better QoL, meanwhile, those who practice low PA levels were significantly associated with poor QoL. Conclusion: The findings revealed that age and PA were associated with QoL. Thus, the healthcare profession must emphasise regular PA to accomplish a better QoL amongst older people in the future.

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.

Pediatric inflammatory bowel disease (PIBD) is a multisystem disorder characterized by intestinal and extraintestinal manifestations and complications. Cerebrovascular events (CVE) are rare extraintestinal complications in patients with PIBD. Statistics show that 3.3% patients with PIBD and 1.3–6.4% adult patients with inflammatory bowel disease (IBD) experience CVE during the course of the disease. Therefore, this study aimed to review the records of children with IBD who developed CVE during the course of the disease. We retrospectively reviewed 62 cases of PIBD complicated by CVE. The mean patient age at the time of thrombotic events was 12.48±4.13 years. The incidence of ulcerative colitis was significantly higher than that of Crohn’s disease (43 [70.5%] vs. 13 [21.3%] patients). Most patients (87.93%) were in the active phase of IBD at the time of CVE. The mean time interval between the onset of IBD and CVE was 20.84 weeks. Overall, 11 (26.83%) patients showed neurological symptoms of CVE at disease onset. The most frequent symptom on admission was persistent and severe headaches (67.85%). The most common site of cerebral venous thrombosis was the transverse sinuses (n=23, 53.48%). The right middle cerebral artery (n=3, 33.34%) was the predominant site of cerebral arterial infarction. Overall, 41 (69.49%) patients who were mostly administered unfractionated heparin or low-molecular-weight heparin (56.09%) recovered completely. Patients with IBD are at a risk of thromboembolism.CVE may be the most common type of thromboembolism. Based on these findings, the most common risk factor for CVE is IBD flares. In patients with CVE, anticoagulant therapy with heparin, followed by warfarin, is necessary.

Introduction: Postnatal is a transition process for the mother back to her non-pregnancy state and involves the changes in hormones level. During the postnatal period, many health issues need to be addressed for both mother and newborn. One of the upsetting health issues for the mother due to the increasing trend is postnatal depression and if it is not identified and treated early, it may cause further complicated problems not only to the mother but also to the baby, family, and local community. With this issue, the Ministry of Health Malaysia has taken a few initiatives to encourage the postnatal mother to also practice the non-medical approaches or traditional postnatal care (TPC) as a self-care for the prevention of postnatal depression. Aim: To systematically identify and review studies examining the influence of TPC on postnatal mothers. Design & Data Sources: A systematic search strategy on the research trend for the period between the years 2013 to 2020 through the Scopus database, Science Direct, and PubMed database. Methods: This review has identified 7 journal articles based on the preferred reporting items for the systematic reviews (PRISMA) framework. Results: There are many methods of TPC, such as traditional postnatal body massage, herbal consumption, herbal bath, body steaming, and body wrapping based on own culture and beliefs. Besides the TPC preparation and techniques, some studies also describe the effects of TPC on a mother’s health and wellness. Conclusion: TPC shows encouraging health trends, and it helps to enhance the well-being and good health of postpartum mothers.

The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs.This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.