Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management.

Tracheal stenosis is a rare complication of endotracheal intubation with serious sequelae. Its early manifestations can be mistakenly diagnosed as other pathology such as asthma or pneumonia. We report a case of a young lady with a history of endotracheal intubation, presenting with a history of noisy breathing for two months. Diagnosis of tracheal stenosis was made using flexible nasopharyngolaryngoscopy and neck radiograph. She was successfully treated by serial direct laryngoscopy and dilatation.

Introduction: Malnutrition, specifically undernutrition, in community-dwelling older adults reduces their well-being and predisposes to diseases. Therefore, timely malnutrition identification through nutrition screening is needed to identify at risk and malnourished patients. This study aimed to develop the content of nutrition screening guideline to facilitate healthcare staffs in health clinics to administer a validated nutrition screening tool specifically for older adults. Methods: A scoping review was conducted electronically using SCOPUS, PubMed, ProQuest Health & Medical Complete, and Cochrane databases. The systematic search was performed up to 31st December 2021. Search terms were created for identification of eligible and related articles. Inclusion and exclusion criteria were determined for the systematic search. The search was limited to English and Malay languages, and full text articles with no limitation of years. All data were extracted and analysed, guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results: From 728 identified articles, 18 articles were included in the analysis. Identified information for the guideline content were: introduction, aims and objectives, definition of malnutrition, prevalence of malnutrition, implementation of nutrition screening, guidance on administering items in validated tools, and guidance on anthropometric measurements. Meanwhile, format and flow charts from established guidelines served as references for the guideline development process. Conclusion: Appropriate content to develop a nutrition screening guideline has been identified based on this review. Development of a guideline based on this content can facilitate healthcare staffs to perform timely nutrition screening in older adults.

Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition identification through nutrition screening needs to be performed routinely in health clinics. However, the nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim. Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years) attending the sampled health clinics. Both data from the interviews and observations were analysed thematically using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6), medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty- one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition screening guideline may facilitate healthcare staff in performing nutrition screening.

Introduction: Elderly population is more likely to suffer from malnutrition, thereby requiring appropriate nutrition education as part of nutrition intervention to overcome this issue. This review aims to identify content suitable for developing a nutrition resource kit that provides nutritional guidance to combat malnutrition among malnourished and at-risk elderly in health clinics setting, particularly in Malaysia. Methods: A literature search was conducted up to 15th December 2019 in four databases: PubMed, Scopus, COCHRANE, and ProQuest Health & Medical Collection. Potential literature on nutrition education, suitable dietary guidelines and existing educational materials for elderly in the community, in English and Malay languages, were searched to identify suitable content for the nutrition resource kit. All relevant documents were included based on inclusion and exclusion criteria. Data were extracted and analysed according to the PRISMA-ScR guidelines. Results: A total of 27 documents consisting of articles, printed materials and guidelines were included for analysis. Suitable content included information related to malnutrition such as definition, signs and symptoms, cause-consequences, and nutrition management, which included food plate, serving size, menu suggestion, examples of recipes, tips to increase energy and protein intakes through food or drink, texture modification, a guide to using oral nutritional supplements, tips for maintaining nutrient content in food and drink, tips to encourage to eat, and oral health. Conclusion: A nutrition resource kit tailored for malnourished and at-risk elderly would be a beneficial nutrition intervention. There is a need to incorporate these information in the development of a nutrition resource kit to improve their dietary intake.

Objective: The purpose of this study was to determine the level of psychosocial burden and its associated risk factors among women with abnormal Pap smear and post colposcopy. Methods: A cross-sectional study was conducted employing universal sampling of 218 respondents with abnormal Pap smear and post colposcopy. They fulfilled the specific inclusion and exclusion criteria. Three tertiary hospitals in the East Coast of Malaysia were participated. Self-administration of validated Malay-version Psychosocial Effect of Abnormal Pap smear Questionnaire was used to assess the psychosocial burden. The General Health Questionnaire-12 (GHQ-12) was applied to assess the general health factor. Data was analyzed using IBM-SPSS of version 22. Results: The results showed that respondents with an abnormal Pap smear and post-colposcopy women (43.1%) demonstrated a high level of psychosocial burden. The significant risk factor of psychosocial burden was living in an urban and semi-urban area of residence (p = <0.001) and distress condition (p = <0.001) respectively. Conclusions: A substantial number of women with abnormal Pap smear results were experiencing psychosocial burden. Women with an abnormal Pap-smear who were living in the urban and semi-urban and distressed were more likely to experience a higher psychosocial burden.

PURPOSE: The p15(Ink4b) gene exerts its influence as an inhibitor of cyclin-dependent kinases and is frequently associated with hematological malignancies. Inactivation of this gene through DNA methylation has been found to be the most prevalent epigenetic alteration reported, with a high frequency in all French-American-British subtypes of acute myeloid leukemias, including acute promyelocytic leukemia (APL). In this study,we investigated the prognostic significance of p15 gene promoter hypermethylation and its expression in APL patients of Kashmir (North India). MATERIALS AND METHODS: p15 gene promoter hypermethylation was conducted by methylation-specific polymerase chain reaction, while its subsequent expression analysis was carried out by semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: Of the 37 patients, 16 (43.2%) were found to have methylated p15 genes. Of these 16 cases, seven (43.8%) were methylated partially and nine (56.2%) were found to have complete methylation. Moreover, nine of the 37 patients (24.3%) who presented with leukocytosis at their baseline had complete p15 gene methylation as well (p < 0.05). Semiquantitative RT-PCR showed a complete loss of p15 expression in nine patients with complete methylation coupled with leukocytosis (p=0.031), while seven patients with partial methylation showed decreased p15 expression. Six patients relapsed during the maintenance phase of treatment and were found to have a completely methylated p15 gene and no p15 mRNA. CONCLUSION: Complete methylation and loss of p15 gene expression causes susceptibility to relapse and decreased survival in APL patients. Thus, p15 promoter hypermethylation is a prospective prognostic indicator and a reliable clinical aid in assessment of patients with APL.
Cyclin-Dependent Kinases ; DNA Methylation ; Epigenomics ; Gene Expression ; Hematologic Neoplasms ; Humans ; Leukemia, Myeloid, Acute ; Leukemia, Promyelocytic, Acute* ; Leukocytosis ; Methylation ; Polymerase Chain Reaction ; Prognosis* ; Prospective Studies ; Recurrence ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger

PURPOSE: The p15(Ink4b) gene exerts its influence as an inhibitor of cyclin-dependent kinases and is frequently associated with hematological malignancies. Inactivation of this gene through DNA methylation has been found to be the most prevalent epigenetic alteration reported, with a high frequency in all French-American-British subtypes of acute myeloid leukemias, including acute promyelocytic leukemia (APL). In this study,we investigated the prognostic significance of p15 gene promoter hypermethylation and its expression in APL patients of Kashmir (North India). MATERIALS AND METHODS: p15 gene promoter hypermethylation was conducted by methylation-specific polymerase chain reaction, while its subsequent expression analysis was carried out by semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: Of the 37 patients, 16 (43.2%) were found to have methylated p15 genes. Of these 16 cases, seven (43.8%) were methylated partially and nine (56.2%) were found to have complete methylation. Moreover, nine of the 37 patients (24.3%) who presented with leukocytosis at their baseline had complete p15 gene methylation as well (p < 0.05). Semiquantitative RT-PCR showed a complete loss of p15 expression in nine patients with complete methylation coupled with leukocytosis (p=0.031), while seven patients with partial methylation showed decreased p15 expression. Six patients relapsed during the maintenance phase of treatment and were found to have a completely methylated p15 gene and no p15 mRNA. CONCLUSION: Complete methylation and loss of p15 gene expression causes susceptibility to relapse and decreased survival in APL patients. Thus, p15 promoter hypermethylation is a prospective prognostic indicator and a reliable clinical aid in assessment of patients with APL.
Cyclin-Dependent Kinases ; DNA Methylation ; Epigenomics ; Gene Expression ; Hematologic Neoplasms ; Humans ; Leukemia, Myeloid, Acute ; Leukemia, Promyelocytic, Acute* ; Leukocytosis ; Methylation ; Polymerase Chain Reaction ; Prognosis* ; Prospective Studies ; Recurrence ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger

Objective: To identify the differential expression of candidate gluconeogenic genes which may initiate hepatitis C virus (HCV) related metabolic disorder during early stages of disease. Methods: Patients of diverse age and sex, with positive HCV genotype 3 (HCV-3) RNA in serum and with no history of other related infections, co-infections, alcoholism, diabetes or chemotherapeutic treatments were considered for this study. Semi-quantitative reverse transcriptase PCR analysis and quantitative fold change analysis of the fresh liver biopsies of eight chronically infected HCV-3 patients and six healthy individuals were evaluated for three potential biomarkers involved in glucose homeostasis induction, namely mitochondrial phosphoenolpyruvate carboxykinase 2 (PCK2), glucose-6-phosphatase catalytic subunit (G6PC) and associated forkhead box protein 01 (FOXO1). Results: Symptomatic evaluation, clinical history and blood test were conducted according to general disease prognosis procedures and reported here. Significantly upregulated expression of PCK2 independent of age, sex and viral infectivity levels in all HCV patients was observed, whereas no significant changes in the expression of G6PC and FOXO1 were found. Conclusions: PCK2 triggers initial gluconeogenic reactions which ultimately result in the accumulation of glycogen in the liver hepatocytes. We therefore suggest that the overproduction of PCK2 has important physiological role in the onset of metabolic disorder in the HCV-3 patients.

Aims: The emphasis of this study is to generate new valuable bioproducts from non-toxic cleaning waste for environmental healing technology. Methodology and Results: Comparisons between different types of biofertilizer formulations and the field trial effectiveness were done. Results indicated that biofertilizer C contained the highest N value (1.8%) when compared with biofertilizers B and A, which only contained 1.7% and 1.4%, respectively. Biofertilizer A showed significant difference in the total count of yeast, mould, ammonia oxidizing bacteria and nitrate oxidizing bacteria compared to biofertilizer B and C. Meanwhile, biofertilizer C was found to be significantly different from others in Lactobacillus sp. and nitrogen-fixing bacteria count. Photosynthetic total count and Actinomycetes sp. were not noticed in all formulations tested. Conclusion, significance and impact of study: The findings of this study suggest that biofertilizer A is suitable to be used as a promotional biofertilizer in flower and fruit production, biofertilizer B can be used for a leafy crop, while biofertilizer C is good for the growth of roots and stem of plants.