Introduction: There is an increasing demand for additional techniques to diagnose and treat cancer including CRC or colorectal cancer effectively. Utilizing antibodies as biomarker could contribute to accurate diagnosis of cancer due to its high specificity and sensitivity. One of the etiologies of CRC progression was proposed as the alterations of hexosamine biosynthetic pathway which could subsequently influence the rate-limiting enzyme, glutamine-fructose-6-phosphate aminotransferase (GFAT1). These increased enzymatic activities resulted in an elevation of glucose uptake that provides nutrients facilitating the progression of cancer cells. Therefore, we attempted to determine the potential of GFAT1 as the biomarker for CRC by correlating its expression with clinicopathological features of the patients. Methods: A total of 132 10% formalin-fixed paraffin embedded tissue were retrieved. Immunohistochemistry (IHC) was performed on the tissue sections and digital images were subsequently acquired. All the images were automatedly analyzed using IHC Profiler. GFAT1 immunoreactivity in colorectal tissues was calculated using an adapted H-score formula. Clinicopathological features of the patients were statistically correlated with the status of GFAT1. Results: Colorectal adenocarcinoma tissues had the significantly highest GFAT1 H-scores with the mean of 103.18 compared to adenoma and non-tumor tissues. There have been no significant associations between clinicopathological characteristics of the patients and the status of GFAT1 except for tumor size. Conclusion: Immunoreactivity of GFAT1 was significantly different between non-tumorous tissues and adenocarcinoma as well as between adenoma and adenocarcinoma tissues. GFAT1 could serve as one of the prognostic biomarkers or useful targets.

Introduction: Dietary inflammation is a significant risk factor for age-related cognitive impairments among older adults. However, information related to the relationship between Empirical Dietary Inflammatory Index (eDII) score and cognitive frailty (CF) among Malaysian community-dwelling older adults is still limited. The objective of this study is to determine the association between dietary inflammatory risk and CF among community-dwelling older adults. Method: This is a cross sectional study involving community-dwelling older adults in Klang Valley. The Fried’s Criteria and Clinical Dementia Rating (CDR) were used to determine CF status. Subjects were also interviewed using the Dietary History Questionnaire (DHQ) and eDII food checklist to assess the food intake and dietary inflammatory risk. Data collected was analyzed using SPSS version 26.0. Results: A total of 158 older adults (66.7 ± 5.2 years old) residing in Klang Valley were involved. Energy and macronutrients have a weak positive association with pro-inflammatory score (p<0.05). There is no significant mean difference between CF older adults consumed a more pro-inflammatory diet (mean 2.07 ± 1.10) compared to non CF (mean 2.06 ± 1.14). However, white rice food item significantly consumed by CF people (22.4%) than non CF (8.5%) (p<0.05). Conclusion: CF older adults were more likely to consume a pro-inflammatory diet particularly from the rice food group. There is a need to further assess the risk of consuming a pro-inflammatory diet using larger sample size and appropriate biomarkers.

Purpose: The impact of the coronavirus disease 2019 crisis on medical education includes reduced clinical training, a significant loss of learning time and a probable decline in confidence of being a doctor. These recent changes will have significant effect on the well-being of medical students and interventional support needs to be given early. This study explores the challenges faced and coping strategies used by preclinical medical students during the crisis. Methods: A qualitative study involving 13 preclinical medical students was conducted between August and September 2020 at a medical school in Malaysia. An in-depth individual interview via Microsoft Teams (Microsoft Corp.) with semi-structured questions was conducted. The recorded interview data were thematically analyzed using the six phases of Braun and Clarke’s Thematic Analysis. Results: The challenges faced were identified under three themes: psychosocial impact of lockdown, significant lifestyle changes, and impact on professional progression. Meanwhile, four themes emerged in coping strategies that include behavioral strategies, re-appraisal of the uncertainties of situation, active coping mechanisms, and regulation of emotion with coping reserve. There are indications that personality traits determine strategies to cope with challenges faced during the crisis which may either lead to resilience building or experiencing burnout. Conclusion The findings of the study highlighted the urgent need to develop early preventive and intervention strategies to address the mental health of medical students to mitigate stress and promote positive well-being in times of crisis.

ABSTRACT Various grafting materials are utilised to facilitate regeneration. There is currently a paradigm shift towards applying poly lactic-co-glycolic acid (PLGA), which is regarded as an excellent scaffold for tissue engineering. Concentrated growth factor (CGF) has also been reported to promote wound healing. Nevertheless, the role of PLGA microspheres as a substitute for bone graft material with CGF in bone regeneration remains unclear. This study was designed to evaluate the effect of CGF with PLGA on bone formation and the expression of alkaline phosphatase (ALP) following socket preservation. PLGA microspheres were prepared using double solvent evaporation method and observed under scanning electron microscopy (SEM). A 6 mL of rabbit’s blood was collected from the marginal ear vein and centrifuged to obtain CGF. Blood was also collected for ALP assessment from 24 New Zealand White (NZW) male rabbits subjected to the first upper left premolar extraction. Sockets were filled with CGF, PLGA, CGF+PLGA or left empty and observed with microscopic computed tomography (micro-CT) at four weeks and eight weeks. The SEM image revealed a spherical shape with interconnected pores on the surface of the PLGA particles. Repeated measures ANOVA were used to evaluate the effect of time and treatment (p < 0.05) with significant differences in bone width, height, volume, volume fraction and expression of ALP was observed with CGF+PLGA. Both CGF and PLGA have the potential as the alternative grafting materials and this study could serve as an ideal benchmark for future investigations on the role of CGF+PLGA in bone regeneration enhancement.
Bone Regeneration ; Platelet-Derived Growth Factor ; Polylactic Acid-Polyglycolic Acid Copolymer

Introduction: Most women with postpartum depression (PPD) remain undiagnosed and untreated, despite the adverse effects known to be felt by women and children. The aim of this study was to examine the coping strategies and help seeking behavior used by women having symptoms of postpartum depression. Methods: Using a mixed-method study design, the researcher used the Edinburgh Postnatal Depression Scale (EPDS), Brief COPE and General Help Seeking Behavior (GHSQ) inventories for the quantitative approach, while the qualitative approach was conducted by a semi-structured interview based on the topics listed. A total of 30 respondents participated in the quantitative study while seven respondents were chosen for the qualitative study. Results: Data analyses identified coping strategies with domains of emotion-focused and religion-focused subscales as the main coping styles, while help seeking behavior identified that families were the main groups of people that were sought by them. Conclusion: Women with symptoms of postpartum depression tended to cope with their mental health issues by strengthening their spiritual bonds and with help and support from their family members.

Introduction: Type 2 diabetes mellitus is a chronic disease which is highly prevalent in Malaysia. In managing diabetes, the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) have advocated self-management to be the basic component of diabetes care. However, an ongoing discussion, education and assessment of the patient’s diabetic knowledge should be implemented in the patient’s empowerment process. There are various assessment tools available worldwide but very few are available in the Malay language. This study is aimed to perform the Malay translation of the Simplified Diabetes Knowledge Test (DKT) questionnaire and validate it. Methods: Forward-backward translation procedure was used to translate the simplified version of the DKT questionnaire. A total of 120 respondents with type 2 diabetes mellitus from a selected government health clinic were recruited to answer the questionnaire which consists of socio-demographic, diabetes characteristics and the 20-item Malay version of simplified DKT questionnaire. Reliability and construct validity were tested with Cronbach’s alpha coefficient and Exploratory Factor Analysis. Results: Factor analysis with Varimax rotation identified five meaningful domains for the final 18 items. The Cronbach’s alpha for the overall scale of the translated questionnaire was 0.573 with values of each five significant domain’s Cronbach’s alpha ranged from 0.370 to 0.564. Conclusion: The Malay version of simplified DKT is valid and reliable to be used as a brief assessment of knowledge among Malaysian diabetic patients.

Introduction: The use of assessment tools to measure postnatal mental illness is essential in healthcare settings. However, variations in the types of tools and their reliability in a particular population lead to under-recognition of mental health status in postnatal mothers. The aim of this review is to evaluate the most recent 10 year of research on the validity and reliability of postnatal mental illness assessment tools. Methods: A literature search of studies from online databases PubMed, Scopus, and Science Direct was conducted. Results: A total of 59 studies were selected for this review. Several studies utilised multiple assessment tools, and a total of 96 assessment tools were identified and classified into six domains: postnatal blues, postnatal stress, postnatal anxiety, postnatal depression, postnatal psychosis, and postnatal psychological disorder. In this review, EPDS was the most common tool used to identify postnatal depression and anxiety while DASS 21 was the most common tool used to identify postnatal psychological disorder. There is a wide range in preponderance of evidence for the reliability of each assessment tool and there were inconsistencies in assessing the validity of the assessment tools. Conclusion This review provides information regarding some of the main assessment tools currently available to measure postnatal mental illnesses. There were no standardised tools that were used in a particular setting. The results may differ in different population because there are differences in not only languages and dialects, but also cultural and racial backgrounds, which greatly influences their perception and interpretation of postnatal mental illness.
Mental Disorders

Syzygium polyanthum is traditionally used as anti-hypertensive agent. However, the nephroprotective effects of S. polyanthum against hypertensive induced chronic kidney disease has yet to be elucidated. This study was conducted to determine the antioxidant properties and nephroprotective effects of aqueous extract of S. polyanthum (AESP) in the spontaneous hypertensive rat model (SHR). The phytochemical constituent was identified using the phytochemical screening and HPLC methods. The in vitro antioxidant activities were determined by DPPH radical scavenging and ferric reducing antioxidant power (FRAP) assays. Fifty male SHR were equally divided into 5 groups, (n=10/group); Untreated-SHR, 20 mg/kg Losartan-treated SHR, 1500 mg/kg AESP treated SHR, 1750 mg/kg AESP treated SHR and 2250 mg/kg AESP treated SHR, while 10 male Wistar Kyoto rats (WKY) were used as control. Losartan and AESP were administered by oral gavage. Rats were sacrificed after 12 weeks of experiment. The phytochemicals include phenolics, flavonoids and alkaloids were identified. AESP has high antioxidant activity as shown by antioxidant assays. AESP normalised systolic blood pressure (p<0.05) and significantly improved renal function (p<0.05). AESP also significantly reduced malondialdehyde (MDA) (p<0.05) and increased superoxide dismutase (SOD) levels in the serum as compared to untreated-SHR group (p<0.05). Ultrastructure of renal damage improved by supplementation of AESP. Conclusively, S. polyanthum is potential to alleviate hypertensive induced chronic kidney disease through its antioxidant properties.

Introduction: Cardiovascular disease is the leading cause of death worldwide. Despite the proven benefit of secondary prevention medications (SPMs), their utilisation remains suboptimal in many countries. This study aimed to assess the use of SPMs in a Malaysian primary care clinic and factors associated with it. Methods: A retrospective review of electronic medical records was conducted to assess the prescription of SPMs among patients with coronary artery disease who attended the clinic between 1st January 2018 and 31st December 2018. Prescriptions of SPMs were documented in numbers and percentages. Multiple logistic regressions were used to analyse factors associated with the prescription of SPMs. Results: Of the 662 patients included in the study, 99.1% were prescribed statins, 97% antiplatelets, 81.7% angiotensin-converting enzyme (ACE)-inhibitors or angiotensin Ⅱ receptor blockers (ARBs), and 78.7% beta-blockers. Male patients were more likely to be prescribed statins (OR = 8.584, 95% CI: 1.431 – 51.510) and antiplatelets (OR = 6.818, 95% CI: 2.294 – 20.257). Another significant factor for antiplatelets prescription was having diabetes (OR = 3.318, 95% CI: 1.148 – 9.590). Having hypertension was associated with ACE-inhibitors or ARBs prescription (OR = 4.008, 95% CI: 2.522 – 6.370). Conclusion: Although the majority of patients received SPMs, there were significant disparities for some SPMs prescriptions among female patients. As these medications are widely available in the Malaysian primary care setting, steps should be taken to ensure that these medications are prescribed equally for all eligible patients.

Introduction: This preliminary study aimed to non-invasively evaluate choline (CHO), creatine (Cr) and intramyocellular lipid (IMCL) metabolites in skeletal muscles at pre- and post-functional electrical stimulation (FES) exercise among incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale (ASIA-AIS) D patients using proton magnetic resonance spectroscopy or 1 H-MRS. Methods: These metabolites were measured from the vastus lateralis and semitendinosus muscles of three incomplete SCI ASIA-AIS D patients who completed the FES exercise and later underwent 3 Tesla (T) MRI (repetition time/echo time; TR/TE of 3500ms/100ms, field-ofview; FOV of 20cm, slice thickness of 6mm) and 1 H-MRS (TR/TE of 2000ms/31ms, voxel size of 20mm x 20mm x 35mm). Results: Out of those selected metabolites, only CHO value of vastus lateralis showed a statistically significant difference between pre- and post FES exercise 1 H-MRS scanning (p = 0.01). Conclusion: Therefore, this preliminary finding has postulated that the quantification of muscle metabolites using 1 H-MRS imaging could be used as a potential indicator in evaluating the muscle strength for incomplete SCI ASIA-AIS D patients after the completion of FES cycling exercise.