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Abstract Background Acrocyanosis is characterised by persistent bluish discolouration of the extremities, resulting from reduced peripheral blood flow leading to increased oxygen extraction. The aetiology can be divided into primary and secondary causes. While primary acrocyanosis is generally painless and has a benign course, secondary causes may lead to complications. This case reported acrocyanosis secondary to cutaneous vasculitis which progressed to digital gangrene, which is a rare complication of cutaneous vasculitis. Case presentation A 68-year-old man presented with a four-day history of bluish discolouration involving bilateral toes associated with pain and started to become gangrenous. Investigations for critical limb ischemia did not show evidence of critical arterial stenosis. Further history revealed history of recent administration of intramuscular injections with diclofenac, a non-steroidal anti-inflammatory agent for renal colic pain a few days prior to the onset of the. Thorough skin search showed multiple purpuric rash of his thighs, buttocks and abdomen. Skin biopsy confirmed the diagnosis of cutaneous (lymphocytic) vasculitis, which was likely to be drug-induced. The acrocyanosis initially responded to methylprednisolone, however unfortunately it progressed further to digital gangrene which required bilateral transmetatarsal amputations. Conclusion Knowledge on clinical features, aetiology and investigations of secondary acrocyanosis is crucial for early recognition and treatment of the underlying cause to prevent irreversible complications.

Background As the recognition of psychological factors in chronic illness management grows, this study examined the interplay of psychological traits – grit, self-efficacy, resilience, and nature-relatedness – and their collective impact on the Quality of Life (QoL) among patients with rheumatoid arthritis (RA) in Malaysia.Methods A cross-sectional study was conducted among 222 patients with RA at a private hospital in Malaysia. Utilizing validated scales, including the Connor-Davidson Resilience Scale, Short Grit Scale, Nature Relatedness Scale, and Arthritis Self Efficacy Scale, data were collected. Pearson Product-moment Correlation analyses assessed the relationships between variables, and a multiple mediation analysis explored the mediating effects of resilience, grit, and self-efficacy on the relationship between nature-relatedness and QoL.Findings Of the 222 participants (86% female, mean age = 56.03, S.D. = 13.42), the analysis revealed a significant mediating role of resilience in the relationship between nature-relatedness and QoL among RA patients (b = −.117, SE = .042, 95% BCa CI [−.208, –.046]). Although grit and self-efficacy positively correlated with QoL, they did not serve as significant mediators in the nature-relatedness – QoL relationship. This highlights the pivotal role of building a sense of resiliency among patients with RA.Interpretation Individuals with RA are not only resilient in terms of their psychological traits such as grit, self-efficacy, and general resilience but also exhibit resilience in their connection and interaction with the natural environment (nature-relatedness). This holistic concept recognizes that fostering resilience in both psychological aspects and the context of one's environment is crucial for promoting overall well-being, particularly in the management of chronic illnesses like RA. It emphasizes the interconnectedness of psychological factors and environmental engagement in contributing to an individual's ability to cope and thrive despite health challenges.

Abstract Background There is strong evidence showing the association between obesity, type 2 diabetes mellitus (T2DM), and knee pain resulting from osteoarthritis. Regular exercise has been reported as a foundational piece of the preventive therapy puzzle for knee osteoarthritis (KOA) patients. Nonetheless, evidence-based exercise protocols for people with comorbidities, such as obesity, T2DM, and KOA are limited. Therefore, the present trial aimed to assess the effectiveness of a 12-week home-based circuit training (HBCT) protocol on various indices related to cardiometabolic health, musculoskeletal fitness, and health-related quality of life (HRQoL) among overweight/obese older adult patients with KOA and T2DM during the COVID-19 lockdown. Methods This is a randomized controlled trial study registered at the National Medical Research Register (ID: RSCH ID-21-01180-KGTNMRR ID-21-02367-FUM) and obtained approval on December 9, 2021. Seventy overweight or obese patients with KOA and T2DM (62.2 ± 6.1 years; 56% female) were randomly assigned to the intervention group (n = 35, HBCT) or the no-exercise control group (n = 35, CON). HBCT performed a 12-week progressive protocol (seven exercises; 15–30 repetitions per exercise, 1 min passive rest between exercises; 2–4 rounds per session; 20–60 min total session duration). Blood samples were collected, and assays were performed to assess the lipid profile, liver function, and fasting blood glucose (FBG). In addition, the 30-s Chair Stand Test (30CST) was used to evaluate lower body muscular strength and endurance while the Timed Up and Go (TUG) test was used to evaluate lower limb function, mobility, and the risk of falls for all the participants. HRQoL was assessed using the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL). All the assessments were conducted at pre-, mid-, and post-training stages during the application or practice of the exercise protocol, rather than during the training sessions themselves. Results HBCT significantly reduced total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), aminotransferase, alanine aminotransferase, FBG and knee pain (p

Background Due to the worldwide reach of the COVID-19 pandemic, authorities across the globe deemed it essential to enforce exceptional containment measures. Maintaining physical activity (PA) during this time was only feasible through engaging in activities at home. Therefore, this study focused on elucidating the levels of PA and well-being among Somali students in the aftermath of the lockdown measures implemented by governments at the onset of the COVID-19 pandemic. Methods This study was conducted in Somalia among undergraduate students studying at Somali International University. A total of 1266 students were included in the present study. An online survey was utilized to measure participant PA behavior. The assessment of PA was conducted in the aftermath of the COVID-19 pandemic, utilizing the Godin Leisure questionnaire. The study showed that 85.8% of the study participants (n = 1086) were between the ages of 17 and 22. More than half of the participants (58.7%, n = 743) were female and had no other employment (57.3%, n = 743). Results Jogging was the most frequently reported PA (57.3%, n = 726), and PA level was on average 59.7 minutes per day (SD = 25.9). Also, most of the study participants were in their last year (82.1%). In the regression analysis, age, gender, academic year, and work status were significant predictors of being physically active after the COVID-19 pandemic. Conclusion Factors affecting PA after the COVID-19 pandemic include age, gender, academic year, and work status. Males, younger individuals, and those who engage in outdoor exercise are more likely to be physically active. Once the COVID-19 restrictions were relaxed, undergraduate students in Somalia were physically active. A high level of PA appears to be advantageous for public health. Universities in Somalia should uphold school policies that promote an active lifestyle among students, aiming to maintain or enhance the existing level of PA.

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease caused by John Cunningham virus (JCV) that affects immunocompromised individuals, particularly human immunodeficiency virus (HIV)-positive. Classical symptoms of PML alter mental status, causing paralysis and diplopia. Bizarre presentations, such as seizures and personality change, are rare in PML, which may lead to a delay in diagnosis and treatment. A 31-year-old HIV-positive Malay man on antiretroviral therapy (ART), presented with two episodes of generalized tonic-clonic seizures. First brain MRI showed a solitary right frontal lobe lesion, for which brain biopsy revealed inflammatory infective process with normal cerebrospinal fluid (CSF) examination, and led to diagnosis of primary lymphoma. Four months later, the patient developed progressive personality changes, reduced cognitive function, and left upper limb paralysis. Second brain MRI showed progression of asymmetrical distribution of white matter changes involving sub-cortical, deep, and periventricular area, a classical feature of PML. ART and intensive neuro-rehabilitation were continued, and the patient’s condition slowly improved; however, cognitive function remained affected. Our case is the first reported case of PML with HIV, who survived six years after diagnosis despite initial diagnostic dilemma and poor prognostic factors. This case illustrates that survival is possible with compliance with ART and intensive rehabilitation.

Background Structured aerobic or resistance training alone seems to be a beneficial tool for improving glucose homeostasis, chronic systemic inflammation, resting cardiovascular function, and mental health in people with obesity and type 2 diabetes mellitus (T2DM). The aim of the present study was to synthesize the available data on the effectiveness of combined aerobic and resistance training (CART) on glycemic control, blood pressure, inflammation, cardiorespiratory fitness (CRF), and quality of life (QoL) in overweight and obese individuals with T2DM. Methods A database search was carried out in PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Google Scholar from inception up to May 2023. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the reliability of evidence. A random-effects model was used, and data were analyzed using standardized mean differences and 95% confidence intervals. The study protocol was registered in the International Prospective Register of Systematic Reviews (ID: CRD42022355612). Results A total of 21,612 studies were retrieved; 20 studies were included, and data were extracted from 1,192 participants (mean age: 57 ± 7 years) who met the eligibility criteria. CART demonstrated significant improvements in body mass index, glycated hemoglobin, systolic and diastolic blood pressure, C-reactive protein, tumor necrosis factor-alpha, interleukin-6, CRF, and QoL compared to ST. These findings highlight the significance of exercise interventions such as CART as essential elements within comprehensive diabetes management strategies, ultimately enhancing overall health outcomes in individuals with T2DM and overweight/obesity.No differences were found in resting heart rate between CART and ST. An uncertain risk of bias and poor quality of evidence were found among the eligible studies. Conclusion These outcomes show clear evidence considering the positive role of CART in inducing beneficial changes in various cardiometabolic and mental health-related indicators in patients with T2DM and concurrent overweight/obesity. More studies with robust methodological design are warranted to examine the dose-response relationship, training parameters configuration, and mechanisms behind these positive adaptations.

Abstract Background Lifestyle modifications involving diet and exercise are recommended for patients diagnosed with obesity and type 2 diabetes mellitus (T2DM). The purpose of this review was to systematically evaluate the effects of combined aerobic exercise and diet (AEDT) on various cardiometabolic health-related indicators among individuals with obesity and T2DM. Methodology A comprehensive search of the PubMed/Medline, Web of Science, Scopus, Science Direct, Cochrane, and Google Scholar databases was conducted for this meta-analysis. The Cochrane risk of bias tool was used to evaluate eligible studies, and the GRADE tool was used to rate the certainty of evidence. A random-effects model for continuous variables was used, and the results were presented as mean differences or standardised mean differences with 95% confidence intervals. Results A total of 16,129 studies were retrieved; 20 studies were included, and data were extracted from 1,192 participants. The findings revealed significant improvements in body mass index, body weight, waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, fasting blood glucose, fasting plasma insulin, glycated hemoglobin, leptin, interleukin-6, C-reactive protein, and adiponectin (p

Objectives: To review the association of surfactant protein-D with type 2 diabetes mellitus, infections, oxidative stress and inflammation, and the changes in oxidative stress markers in type 2 diabetes mellitus. Method: The systematic review was conducted from April to September 2022, and comprised search on PubMed, Web of Sciences, Scopus, Science Direct and Google Scholar databases for relevant studies published in English language between January 1, 2000, and June 30, 2022. The search was updated in September 2022. After transferring literature to Mendeley, relevant data was extracted from the included studies. Quality assessment for eligible studies was done using Joanna Briggs Institute Critical Appraisal Checklist. Quality of evidences was assessed by using Grading of Recommendations Assessment, Development and Evaluation tool. Results: Of the 203 studies identified, 18(8.9%) were analysed; 16(89%) with humans and 2(11%) with animals as subjects There were 5 (31.25%) studies for SP-D, of which 4 (80%) studies reported lower surfactant protein-D in type 2 diabetes mellitus cases than controls. Its significant negative association with glycated haemoglobin was reported by 1(20%) study and 2(40%) studies with fasting blood glucose levels. Higher surfactant protein-D in type 2 diabetes mellitus cases and its positive association with glycated haemoglobin was reported by 1(20%) study. Recurrent infections were frequent in type 2 diabetes mellitus patients. Malondialdehyde level was higher and superoxide dismutase activity was lower in type 2 diabetes mellitus cases, reflecting oxidative stress. ---Continue

Abstract Background There is a growing body of evidence that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19 infection is associated with the development of autoimmune diseases. A recent systematic review reported that the new-onset autoimmune disorders during or after COVID-19 infection included inflammatory myopathies such as immune-mediated necrotizing myopathies. Case presentation We described a 60-year-old man diagnosed with COVID-19 infection and later presented with a two-week history of myalgia, progressive limb weakness, and dysphagia. He had a Creatinine Kinase (CK) level of more than 10,000 U/L, was strongly positive for anti-signal recognition particle (SRP) and anti-Ro52 antibody, and a muscle biopsy revealed a paucity-inflammation necrotizing myopathy with randomly distributed necrotic fibers, which was consistent with necrotizing autoimmune myositis (NAM). He responded well clinically and biochemically to intravenous immunoglobulin, steroids and immunosuppressant and he was able to resume to his baseline. Conclusion SARS-CoV-2 may be associated with late-onset necrotizing myositis, mimicking autoimmune inflammatory myositis.

Mesotheliomas are malignancies which involve mesothelial cells, and are commonly found in the pleura, peritoneum, pericardium, and (rarely) the testis. We present a case of paratesticular mesothelioma that was excised without the testis. An elderly gentleman presented with a painless right scrotal mass, which appeared clinically benign and separable from the underlying testis. An ultrasound showed an extratesticular lesion adhered to the scrotal wall with a complex hydrocele. An excisional biopsy was conducted, and the Jaboulay procedure was performed on the right testis. Pathological examination revealed mesothelioma, showing focal invasion into the underlying stroma. A post-operative computed tomography (CT) scan evaluation manifested no local or distant metastasis. No further surgery was performed, and no chemotherapy or radiotherapy was offered to the patient. Subsequent clinical examinations and radiological scans carried out during each clinic follow-up for two years showed no new lesion or recurrence.

Bacterial cellulose (BC) is an uprising bio-polymer produced by various bacterial strains, which is infamous for its prominent biological properties and applications. Receiving ample attention due to those unique properties, various genus and bacterial strains have been used for BC biosynthesis and the studies of its production have been recorded throughout the years. Although a lot of research and implementation has been done on BC, studies in the search for low-cost, effective medium contributing to higher BC yields were still in continuation to this day. This review article overviews the employed bacterial strains and their recent advance, modified, and low-cost medium in the development of BC composites. Special emphasis is placed on the new-novel strains for BC production and BC applications. Compilations of literature were compiled to outline the sources and also findings by previous and recent researchers. It was found that numerous studies have attempted to enhance BC production, which includes the utilization of various bacterial strains to fulfill industrial needs. Hence, this review comprises bacterial genera and species, which are mainly used in the production of BC such as Komagataeibacter, Gluconobacter, Gluconacetobacter, Enterobacter, and Pseudomonas.The recent studies enforced on BC focusing on higher production and the application of BC on an industrial scale will also be reviewed.

IntroductionAging is associated with physiological changes in multiple systems in the body and may impact the transportation choices of older adults. In this study, we examine the associations between biopsychosocial factors and the transportation choices of Malaysian older adults.MethodsOne hundred and nineteen (119) older adults, aged 60 and above, living in Klang Valley, Malaysia were recruited for this cross-sectional study. Participants were interviewed face-to-face to obtain sociodemographic data, health status (whether there were and, if yes, the number of comorbidities), outdoor mobility and transportation patterns, Instrumental Activity Daily Living (IADL) status and cognitive function. Participants’ physical performance (dominant handgrip strength, 10-m walk, and timed up and go tests), hearing threshold (pure tone audiometry), and vision function (visual acuity, contrast sensitivity) were measured. Transportation patterns of older adults were categorized into three groups, that is, flexible (using public transport and/or private vehicles), using only private vehicles and restricted (relying on others or walking).ResultsFurther information is needed to enable such older adults as older women, those with comorbidities and poorer functional status to access transportation, especially to meet their health care needs.DiscussionThe majority (51%) of participants were in the ‘using only private vehicles’ group, followed by the ‘flexibles’ (25%) and the ‘restricted’ (24%). Factors significantly associated with the restricted transportation group were: (a) being female (AdjOR 15.39, 95% CI 0.86–23.39, p

The importance of social networks has increased in recent decades, yet the use of social learning in higher education is nascent. Little is known how to foster high levels of social learning discourse among students in higher education classrooms. To address this gap, the present study analyses the use of a mobile application (Soqqle) for sharing student-generated content and peer-to-peer communication. Students from Hong Kong, Malaysia, and Indonesia uploaded videos linked to assessments and received feedback from their instructors and peers through social engagement features (e.g., comments, likes). The majority of students reported that the social learning experience promoted idea generation, increased creativity, and improved attention. These results indicate that integrating online platforms and mobile applications can promote social learning. The findings have important implications for educational practice because many educational institutions have adopted online learning due to the COVID-19 pandemic.

This study determined the properties of 3.2 mm Medium Density Fiberboard (MDF) from a commercial production line. The mixture of fibers from Sesbania aculeate (80%) and Tamarix aphylla (20%) was bound with urea formaldehyde for laboratory testing. Effects of production line speed, fiber moisture content, and production shift on board properties were assessed. Physical and mechanical properties of the panels were determined according to European standards. This study showed that the production of MDF during the evening shift was ideal, with a line speed of 6.00 m/min and fiber moisture content of 8.70 %, compared to morning and night shifts. The production line speed, fiber moisture content, and operation shift affected the properties of MDF boards but met the minimum requirements in the standards. The mix of fibers is a viable combination for commercial production.

Coronavirus disease 2019 is a severe communicable pulmonary medical problem that has been a challenging disease for everyone in the globe, but vaccines development and administration against this severe acute respiratory syndrome-inducing disease (coronavirus disease 2019) are currently yielding fabulous results. The mean duration of the coronavirus disease 2019 pandemic for this study spanned from 2020 until 2022. These manifestations are accompanied by symptoms of respiratory tract illnesses such as non-productive cough, sore throat, and nasal discharge. Relevant reviews on coronavirus disease 2019 manifestations and outcomes, consisting mainly of the infections/outbreaks, experimental information, and pre- and post-serovaccination details that occurred, were described. After a typical vaccination course, the study aims to summarize and understand more about the effectiveness of exercise on the pre-and post-coronavirus disease 2019 vaccination and its implementations. Physical activity is an immunological function adjuvant to decrease communicable disease risk and enhance immunity post-viral infection vaccination. Moderate-intensity resistance exercisesession directly before getting the influenza vaccine decreases vaccine responses in older adults, such as redness, pain, or inflammation at the injection spot or other adverse consequences compared to the inactive circumstance. However, it was reported that exercise after a shot is generally safe as long as vaccinated people feel well enough. Though exercise before or after vaccination has no negative impact on the protection afforded by the vaccine, people can exercise immediately after receiving the vaccine, as any changes in blood flow will not affect the vaccine’s response. One episode of light-to-moderate-intensifying exercise after vaccination may improve the antibody reactions to influenza or the coronavirus disease 2019 vaccine. Vaccination administered pre- and post-regular exercise is an effective approach for boosting antibody responses due to its immunostimulant effects. Future research should investigate how different vaccine antibodies respond to low, moderate, and high physical activity levels.

BackgroundDespite evidence of depression among mothers of children with cancer, there appears to be a lack of studies or concern regarding factors associated with depression among these mothers.ObjectiveTo review the factors associated with depression among mothers of children with cancer.MethodPubmed, Medline, Cochrane, CINAHL, Psychology, and Behavioural Sciences Collection, and Academic Search Complete were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies published between 2010 to 2022 on the associated risk factors of depression among mothers of children with cancer. The keywords used included mothers OR maternal' AND 'Child*' AND 'cancer OR tumo*r OR neoplasm' AND 'factors OR facilitators AND barriers OR predictors OR determinants AND 'depression'. Selected studies were evaluated by quality assessment.ResultFive articles fulfilled the eligibility criteria. The factors associated with depression among mothers of children were socio-demographic risk factors (marital status, education level, annual income, child cancer diagnosis), and stress factors (caregiving stress, cancer-related stress, general stress). There were other factors associated with depression that act as mediators along the process which were emotion-focused coping and perceived social support.ConclusionBesides the commonly reported socio-demographic risk factors (marital status, education level, and annual income), other factors include stress factors (caregiving stress, cancer-related stress, and general stress). Furthermore, emotion-focused coping and perceived social support act as mediators along the process. More studies are warranted to explore depression among these mothers to ensure the most appropriate and effective preventive measures.

ObjectivesTo assess the reliability and validity of two disease-specific questionnaires that assess the quality of life (QoL) among patients with Systemic Lupus Erythematosus (SLE); SLEQoL and LupusQoL in Malay language. This study also identified the factors affecting each domain of the questionnaires.MethodsThis cross-sectional study was conducted from June 2021 until April 2022, and SLE patients were recruited to complete the SLEQoL, LupusQoL and Short Form Health Survey (SF-36) in Malay language. Disease activity were recorded using the modified SLE Disease Activity Index (M- SLEDAI) and British Isles Lupus Assessment Group 2004 (BILAG-2004) index. Presence of organ damage was determined using the SLICC Damage index. Cronbach's alpha was calculated to determine internal consistency while exploratory factor analysis was done to determine the construct validity. Concurrent validity was evaluated using correlation with SF-36. Multiple linear regression analysis was deployed to determine the factors affecting each domain of SLEQoL and LupusQoL.ResultsA total of 125 subjects were recruited. The Cronbach's α value for the Malay-SLEQoL (M-SLEQoL) and Malay-LupusQOL (M-LupusQoL) was 0.890 and 0.944 respectively. Exploratory factor analysis found formation of similar number of components with the original version of questionnaires and all items have good factor loading of >0.4. Both instruments also had good concurrent validity with SF-36. M-SLEQoL had good correlations with BILAG-2004 and M-SLEDAI scores. Musculoskeletal (MSK) involvement was independently associated with lower M-SLEQoL in physical function, activity and symptom domains. Meanwhile, MSK and NPSLE were associated with fatigue in M-LupusQoL.ConclusionBoth M-SLEQoL and M-LupusQoL are reliable and valid as disease -specific QoL instruments for Malaysian patients. The M-Lupus QoL has better discriminative validity compared to the M-SLEQoL. SLE patients with MSK involvement are at risk of poor QoL in multiple domains including physical function, activity, symptoms and fatigue.

It remains unclear whether grain could act as an effective complementary agent for Rheumatoid Arthritis (RA). This study investigated the effects of 12 weeks high fiber multigrain supplementation on disease activity scores, circulating inflammatory and oxidative stress biomarkers in patients with RA. Fifty-four moderate to severe RA patients were randomly assigned to receive either 80 g multigrain supplementation (containing 15.6 g fiber) coupled with prescribed anti-rheumatic regimen (n = 27), or anti-rheumatic regimen alone (n = 27). Multigrain supplementation group showed significant improvement in DAS-28 score (p

Currently, the obstacles faced in learning process are found to be low student interest in learning. The main factor contributing to low student interest in learning is influenced by the lack of variety of learning media used by teachers in schools. The use of augmented reality (AR) in education is classified as an important research topic, although it is still being studied in its early stages. The purpose of this research was to develop learning media using e-magazine based on an AR to increase students' interest in learning. The developed e-magazine was carried out using model of ADDIE (analysis, design, development, implementation and evaluation). Parameters in this study was focused on the quality of e-magazine and students’ interest in learning. Testing students' interest in learning was conducted by using a questionnaire and given directly to students. The experiments were carried out in the control class consisting of 36 students and the experimental class consisting of 36 students. Results of the study found that the development of AR-based e-magazines were obtained in relatively good category. This value was supported by the validation value found in the very valid category. Analysis on the didactic, constructive and technical aspects were obtained a score of 3,82, 3,85 and 3.78, respectively, with a very valid category. The results also showed that the use of AR-based e-magazines could be increased students' interest in learning and students' interest in learning was obtained at a value of 0.342 in the high category. Thus, the use of AR-based e-magazines as digital learning media can be used in the learning process.

Objective: As there is a drastic change in the nature of written literacy, both tertiary level students and educators are expected to maximize the opportunities offered by digital tools like Classkick application when giving and receiving constructive feedback about their language lessons. The purpose of this study was to get feedback from the students, especially about their perceptions of Student Interaction, Student Engagement, Instructor Presence, Student Satisfaction & Perceived Learning in using ‘Classkick’ App for writing lessons as well as to get the learners’ suggestions onto how do we use ‘Classkick’ App to create more interesting lessons. Methodology: The methods used were an adapted questionnaire named Student Learning and Satisfaction in Online Learning Environments Instrument (SLS-OLE) questionnaire and two semi-formal interview questions. 96 students from the Law Faculty at Universiti Teknologi MARA (UiTM) Kampus Dengkil located in Malaysia were chosen as an informant group. Findings: The results indicate that the most common condition concerning students’ readiness in getting constructive feedback is that students get to interact with others using this application in order for them to be engaged with the lecturer’s presence so that it will lead to students’ satisfaction in enabling the construction of their own perceived learning in online classrooms. Implications: The main conclusion was that more constructive feedback received by the students will lead to more motivating factors to learn writing digitally.

Background International restrictions were enacted during the COVID-19 pandemic to limit social interaction and viral transmission. These measures had a negative impact on physical activity (PA), creating changes in students’ health and lifestyles. The present study aimed to evaluate the levels of PA among undergraduate students in three different universities in Mogadishu after the relaxation of COVID-19 lockdown using the international physical activity questionnaire-long version (IPAQ-L) and its potential associated factors. Methods This study is a multicentral study conducted at Somali International University, Horn of Africa University, and Daha International University. A total of 1,189 respondents were asked to answer the online questionnaire provided via a link shared using their social media. Results After COVID-19 restrictions approximately ≥ 150 minutes of PA per week was reported by 500 men (97.3%) and 652 women (96.6%) at work. While 7 (1.4%) of men and 20 (3%) of women participate in < 150 minutes each week, respectively. Furthermore, only seven (1.4%) of males and three (0.4%) of women reported to have not performed any PA at work. Conclusion The majority of the undergraduate students at the selected universities in Mogadishu were physically active after the relaxation of COVID-19 rules in Somalia. Such a high level of PA is a significant advantage to public health.

Background Cancer is a huge group of diseases that can affect various body parts of humans but also has a psychological, societal, and economic impact. Physical activity can improve the quality of life (QOL) and immunity, while moderate intensity exercise can reduce the probability of this lethal disease. The current study aimed to determine the effect of physical activity on immune markers and QOL in cancer patients as well as to evaluate cancer-related fatigue (CRF) and its association with physical activity. Methodology Before starting the study, the study protocol was registered in PROSPERO (registration number CRD42021273292). An electronic literature search was performed by combining MeSH terminology and keywords used with the Boolean operators “OR” and “AND” to find relevant published studies on PubMed, Scopus, Cochrane, and ScienceDirect databases. The Joanna Briggs Institute (JBI) critical evaluation checklist was used to assess the quality of selected studies, while the GRADE approach was used to see the quality of evidence. Results A total of 13,931 studies were retrieved after the search on databases. After the scrutiny of studies by reading the title of articles and the inclusion/exclusion criteria, a total of 54 studies were selected for further screening by reading the full texts. In the final, a total of nine studies were selected for the current systematic review and proceeded for data extraction. The patients who were doing different exercises showed improvements in immunity, QOL, and reduction in CRF. A significant reduction in tumour necrosis factor-α (TNF-α), C reactive protein (CRP), interleukin-8 (IL-8), IL-6, and an increase in natural killer (NK) cells levels was also observed. Conclusions The exercise program is safe and beneficial to improve the quality of life and immunity markers before, during, and after cancer treatment. Physical exercise may also help patients to overcome the adverse effects of the treatment and to reduce the chance of developing new tumours in the future.

Pineapple leaf is categorised as natural fibre resources hence creating an initiative to reduce usage of synthetic fibre. Pineapple fruits commercially have high demand in the industry causing the leaves discarded as agricultural waste. As an alternative to reduce the waste, fibres from pineapple leaf were extracted and dyed to improve the aesthetic value of pineapple leaf fibre by adding dyeing substrates using low energy consumption approach. This research is the first step towards more profound understanding on the nature of colourfastness properties pineapple leaf dyed fibre in addition on the improvement of dyeing behaviour properties. This method could further be refined by considering the production of textile materials, which can provide alternative on the usage of highly expensive silk fibres in the songket making industry. Two different methods of dyeing were used to analyse the colourfastness properties of pineapple leaf fibres. Pineapple leaf fibre was extracted using mechanical extraction. The fibres were manually extracted by water retting process and dried at room temperature prior to dyeing. Red reactive dye was applied to the pineapple leaf fibres using infrared dyeing machine and exhaustion dyeing machine. Both dyeing techniques displayed interesting colour findings, where infrared dyeing with golden shade and exhaustion dyeing with a reddish shade. Both dyeing techniques gave excellent colourfastness to washing with the moderate performance of change in colour.

Of late, dyeing fabrics with natural dyes have become an attraction because of its eco-friendly and less threatening disposition towards humankind. In the textile colouration industry, natural dyes play an important role because of the need for replacement synthetic dyes which have a great deal of tension with the environmental issues. This study focuses on the colour shade, colour coordinates, and fastness properties of dyed silk fabric from tagetes erecta (Mexican Marigold flower) using the water boiling extraction method. The dyeing was carried out using lemon juice as a natural mordant through the simultaneous mordanting method, using two different dyeing methods: infrared (IR) dyeing and exhaustion dyeing. The shades produced for exhaustion dyed fabric is light-yellow compared to the IR dyed fabric, which is medium-light yellow. These shades were confirmed with the CIELAB colour coordinates, L*a*b* values. The colourfastness to washing, perspiration, rubbing, and light of the fabrics were conducted to investigate the performance of the dye and mordant on the dyed silk fabrics. The colourfastness properties of the dyed silk fabric using infrared (IR) dyeing technique have better performance than using exhaustion dyeing technique.

Abstract Background Psoriatic arthritis (PsA) can manifest in various forms. This includes mimicry of other diseases. We describe an unusual mimicry of PsA. Case presentation We report a case of a middle-aged lady who presented with severe pain and morning stiffness over the small joints of the left hand for 3 months and painless deformity of the affected joints 1 year before. She was under treatment for pruritic rash over her ankles and knees for the past 1 year as well. Physical examination revealed a fixed flexion deformity, swelling and tenderness of the left ring and little fingers’ distal interphalangeal (DIP) joints. Left hand radiograph showed sclerotic joint margin, narrowed joint space and marginal osteophytes of the affected DIP joints. Dermoscopic examination showed red- violaceous, flat-topped papules and plaques with minimal scales on both ankles; hyperpigmented scaly plaques over both knees and vertical fingernail ridges. Serum autoimmune screening and inflammatory markers were unremarkable. Left ankle skin biopsy showed features consistent of psoriasis. PsA was diagnosed. Weekly titrated oral methotrexate and topical steroid were started. The patient showed significant improvement after 1 month of treatment. Conclusion PsA is a great mimicker. Dermoscopy is an accessible and valuable tool to assess skin lesions in greater detail. Clinicians should be aware of coexisting diseases or misdiagnosis when patients do not respond to treatment.

Introduction: Hearing acuity, central auditory processing and cognition contribute to the speech recognition difficulty experienced by older adults. Therefore, quantifying the contribution of these factors on speech recognition problem is important in order to formulate a holistic and effective rehabilitation. Objective: To examine the relative contributions of auditory functioning and cognition status to speech recognition in quiet and in noise. Methods: We measured speech recognition in quiet and in composite noise using the Malay Hearing in noise test on 72 native Malay speakers (60–82 years) older adults with normal to mild hearing loss. Auditory function included pure tone audiogram, gaps-in-noise, and dichotic digit tests. Cognitive function was assessed using the Malay Montreal cognitive assessment. Results: Linear regression analyses using backward elimination technique revealed that had the better ear four frequency average (0.5–4 kHz) (4FA), high frequency average and Malay Montreal cognitive assessment attributed to speech perception in quiet (total r2 = 0.499). On the other hand, high frequency average, Malay Montreal cognitive assessment and dichotic digit tests contributed significantly to speech recognition in noise (total r2 = 0.307). Whereas the better ear high frequency average primarily measured the speech recognition in quiet, the speech recognition in noise was mainly measured by cognitive function. Conclusions: These findings highlight the fact that besides hearing sensitivity, cognition plays an important role in speech recognition ability among older adults, especially in noisy environments. Therefore, in addition to hearing aids, rehabilitation, which trains cognition, may have a role in improving speech recognition in noise ability of older adults. Resumo: Introdução: A alteração da acuidade auditiva, do processamento auditivo central e da cognição são fatores que contribuem para a dificuldade de reconhecimento da fala em idosos. Portanto, quantificar a contribuição desses fatores no problema de reconhecimento da fala é importante para a formulação de uma reabilitação holística e efetiva. Objetivo: Examinar as contribuições relativas do funcionamento auditivo e do estado cognitivo para o reconhecimento da fala no silêncio e no ruído. Método: Nós medimos o reconhecimento de fala no silêncio e no ruído composto com o teste Malay hearing in noise test em 72 idosos malaios nativos falantes (60-82 anos) com audição normal a perda auditiva de grau leve. A avaliação da função auditiva incluiu audiograma de tons puros, teste gaps-in-noise e testes dicótico de dígitos. A função cognitiva foi avaliada pelo teste Malay Montreal cognitive assessment. Resultados: Análises de regressão linear com técnicas de eliminação backward na orelha melhor revelaram média de quatro frequências (0,5–4 kHz) (4AF), média de alta frequência e teste Malay Montreal cognitive assessment na orelha melhor, mensurada pela percepção da fala no silêncio (r2 total = 0,499). Por outro lado, a média de alta frequência, Malay Montreal cognitive assessment e o teste dicótico de dígitos contribuíram significativamente para o reconhecimento da fala no ruído (r2 total = 0,307). Enquanto a média de alta frequência da melhor orelha mediu principalmente o reconhecimento da fala no silêncio, o reconhecimento da fala no ruído foi mensurado principalmente pela função cognitiva. Conclusões: Esses achados destacam o fato de que, além da sensibilidade auditiva, a cognição desempenha um papel importante na capacidade de reconhecimento da fala em idosos, principalmente em ambientes ruidosos. Portanto, além de aparelhos auditivos, a reabilitação, que treina a cognição, pode ter um papel na melhoria da capacidade do reconhecimento da fala no ruído entre os idosos. Keywords: Speech recognition, Hearing threshold, Auditory, Cognition, Elderly, Palavras-chave: Reconhecimento de fala, Limiar auditivo, Auditivo, Cognição, Idoso

Anticoagulant-related nephropathy (ARN) is a recently described disease entity which is an underdiagnosed complication of anticoagulation. Despite widespread usage of anticoagulants, ARN is not commonly reported. We report a case of a 64-year old man with biopsy-proven ARN who presented with over anticoagulation and acute chronic kidney injury while on warfarin therapy for his left lower limb deep-vein thrombosis. Various investigations were performed and renal biopsy confirmed the diagnosis of anticoagulant-related nephropathy.

Zinc sulfide (ZnS) thin films prepared using the chemical bath deposition (CBD) method have demonstrated great viability in various uses, encompassing photonics, field emission devices, field emitters, sensors, electroluminescence devices, optoelectronic devices, and are crucial as buffer layers of solar cells. These semiconducting thin films for industrial and research applications are popular among researchers. CBD appears attractive due to its simplicity, cost-effectiveness, low energy consumption, low-temperature compatibility, and superior uniformity for large-area deposition. However, numerous parameters influence the CBD mechanism and the quality of the thin films. This study offers a comprehensive review of the impact of various parameters that can affect different properties of ZnS films grown on CBD. This paper provides an extensive review of the film growth and structural and optical properties of ZnS thin films influenced by various parameters, which include complexing agents, the concentration ratio of the reactants, stirring speed, humidity, deposition temperature, deposition time, pH value, precursor types, and annealing temperature environments. Various studies screened the key influences on the CBD parameters concerning the quality of the resulting films. This work will motivate researchers to provide additional insight into the preparation of ZnS thin films using CBD to optimize this deposition method to its fullest potential.

Bee bread (BB) has traditionally been used as a dietary supplement to treat liver problems. This study evaluated the therapeutic effects of Heterotrigona itama BB from Malaysia on obesity-induced hepatic lipid metabolism disorder via the regulation of the Keap1/Nrf2 pathway. Male Sprague Dawley rats were fed with either a normal diet or high-fat diet (HFD) for 6 weeks to induce obesity. Following 6 weeks, obese rats were treated either with distilled water (OB group), BB (0.5 g/kg body weight/day) (OB + BB group) or orlistat (10 mg/kg body weight/day) (OB + OR group) concurrent with HFD for another 6 weeks. BB treatment suppressed Keap1 and promoted Nrf2 cytoplasmic and nuclear translocations, leading to a reduction in oxidative stress, and promoted antioxidant enzyme activities in the liver. Furthermore, BB down-regulated lipid synthesis and its regulator levels (SIRT1, AMPK), and up-regulated fatty acid β-oxidation in the liver of obese rats, being consistent with alleviated lipid levels, improved hepatic histopathological changes (steatosis, hepatocellular hypertrophy, inflammation and glycogen expression) and prevented progression to non-alcoholic steatohepatitis. These results showed the therapeutic potentials of H. itama BB against oxidative stress and improved lipid metabolism in the liver of obese rats possibly by targeting the Keap1/Nrf2 pathway, hence proposing its role as a natural supplement capable of treating obesity-induced fatty liver disease.

The IL-23/IL-17 axis plays causative roles in the development and progression of systemic lupus erythematosus (SLE). However, it remains unclear if the IL-17RA+ and IL-23R+ T helper (Th) cells populations are associated with the serum IL-17 and IL-23 levels, or with the immunological parameters and disease activities in SLE patients. Herein, we examined the proportion of IL-17RA+ and IL-23R+ Th cells and serum levels of IL-17 and IL-23 in established SLE patients (n = 50) compared with healthy controls (n = 50). The associations of these interleukins and their receptors with immunological parameters [anti-nuclear antibody (ANA), anti-dsDNA antibody, and C-reactive protein (CRP)] and SLE disease activity (SLEDAI-2K scores) in SLE patients were assessed. CD3+CD4+ Th cells of SLE patients demonstrated significantly elevated IL-17RA+ (p = 1.12 x 10-4) or IL-23R+ (p = 1.98 x 10-29) populations compared with the healthy controls. Serum IL-17 levels were significantly lower in SLE patients compared with the healthy controls (p = 8.32 x 10-5), while no significant difference was observed for the IL-23 serum levels between both groups. IL-23R+ Th cells population was significantly associated with higher SLEDAI-2K scores (p = 0.017). In multivariate analysis, the proportion of IL-23R+ Th cells remained significantly associated with higher SLEDAI-2K scores independent of prednisolone intake (p = 0.027). No associations were observed between the interleukin parameters (i.e., IL-17, IL-23, IL-17RA+ Th cells, and IL-23R+ Th cells) with ANA, anti-dsDNA, and CRP status, suggesting that the IL-17/IL-23 axis acts independently of these immunological parameters. In conclusion, our results support that therapeutic inhibition of the IL-23/IL-17 axis receptors on Th cells, particularly IL-23R, is potentially relevant in SLE patients.

Abstract Background Allergy towards systemic corticosteroid is rare. This case report discusses the investigations to confirm diagnosis and alternative treatments. Case presentation A 51-year-old asthmatic woman developed severe anaphylactic reaction following administration of systemic hydrocortisone. Skin prick, intradermal, and intravenous provocation tests confirmed allergy to triamcinolone, hydrocortisone, and dexamethasone. Skin prick tests (SPTs) were negative to all the aforementioned drugs. Intradermal test (IDT) with triamcinolone 1:10 concentration resulted in a 2-mm wheal associated with rhonchi. IDT with hydrocortisone 1:10 concentration showed an 8-mm wheal with rhonchi. IDTs to dexamethasone and carboxymethylcellulose were negative. Generalized rhonchi were observed with intravenous dexamethasone full concentration challenge. Conclusions Corticosteroid allergy should be suspected in asthma patients with worsening bronchospasm after its administration. Due to its rarity, such diagnosis can easily be missed, resulting in increased morbidity and mortality in patients.

The high number of poisoning food and diarrheal diseases caused by Bacillus cereus bacteria has been treated with chemical drugs and traditionally herbal plants. One of the commonly used herbal plants is sweet root (Glycyrrhiza glabra L.). This study aims to extract and fractionate sweet root plants, determine the antibacterial activity and identify the types of bioactive compounds as antibacterial compounds. The extraction process uses a maceration technique and fractionation using buthanol, ethyl acetate, and hexan solvents. Antibacterial activity was carry out by the diffusion method and identification of bioactive compounds by GCMS analysis. This study showed that greatest antibacterial activity was found in ethyl acetate fraction with a strong category and MIC value of 12,5%. This study for the first time also revealed that the types of bioactive compounds from sweet root plants (Glycyrrhiza glabra L.) as antibacterial compounds are n-Hexadecanoic as a fatty acid group and 4H-Pyran 4-one 2.3 dihydro-3, 5-dihydroxy-6 methyl from the flavonoid group.

Atopic dermatitis, the most common form of eczema, is a chronic, relapsing inflammatory skin condition that occurs with dry skin, persistent itching, and scaly lesions. This debilitating condition significantly compromises the patient’s quality of life due to the intractable itching and other associated factors such as disfigurement, sleeping disturbances, and social stigmatization from the visible lesions. The treatment mainstay of atopic dermatitis involves applying topical glucocorticosteroids and calcineurin inhibitors, combined with regular use of moisturizers. However, conventional treatments possess a certain degree of adverse effects, which raised concerns among the patients resulting in non-adherence to treatment. Hence, the modern use of moisturizers to improve barrier repair and function is of great value. One of the approaches includes incorporating bioactive ingredients with clinically proven therapeutic benefits into dermocosmetics emollient. The current evidence suggests that these dermocosmetics emollients aid in the improvement of the skin barrier and alleviate inflammation, pruritus and xerosis. We carried out a critical and comprehensive narrative review of the literature. Studies and trials focusing on moisturizers that include phytochemicals, natural moisturizing factors, essential fatty acids, endocannabinoids, and antioxidants were identified by searching electronic databases (PubMed and MEDLINE). We introduce the current knowledge on the roles of moisturizers in alleviating symptoms of atopic dermatitis. We then further summarize the science and rationale of the active ingredients in dermocosmetics and medical device emollients for treating atopic dermatitis. Finally, we highlight the limitations of the current evidence and future perspectives of cosmeceutical research on atopic dermatitis.

The receptors for IL-35, IL-12Rβ2 and gp130, have been implicated in the inflammatory pathophysiology of autoimmune diseases. In this study, we set out to investigate the serum IL-35 levels and the surface levels of IL-12Rβ2 and gp130 in CD3+CD4+, CD3+CD4─ and CD3─CD4─ lymphocyte subpopulations in systemic lupus erythematosus (SLE) patients (n=50) versus healthy controls (n=50). The potential T cell subsets associated with gp130 transcript (i.e. IL6ST) expression in CD4+ T cells of SLE patients was also examined in publicly-available gene expression profiling (GEP) datasets. Here, we report that serum IL-35 levels were significantly higher in SLE patients than healthy controls (p=0.038) but it was not associated with SLEDAI-2K scores. The proportions of IL-12Rβ2+ and gp130+ cells in SLE patients did not differ significantly with those of healthy controls in all lymphocyte subpopulations investigated. Essentially, higher SLEDAI-2K scores were positively correlated with increased proportion of gp130+ cells, but not IL-12Rβ2+ cells, on CD3+CD4+ T cells (r=0.425, p=0.002, q=0.016). Gene Set Enrichment Analysis (GSEA) of a GEP dataset of CD4+ T cells isolated from SLE patients (n=8; GSE4588) showed that IL6ST expression was positively associated with genes upregulated in CD4+ T cells vs myeloid or B cells (q0.75 with IL6ST expression) upon anti-CD3 stimulation in these SLE patients. In conclusion, gp130 signaling in CD3+CD4+ T cell subsets may contribute to increased disease activity in SLE patients, and it represents a promising therapeutic target for inhibition in the disease.

Background Gouty arthritis is a disease of global burden in which defective metabolism of uric acid causes arthritis. Gouty arthritis or medications used for its treatment may lead to uric acid-associated complications such as upper gastrointestinal bleeding (UGIB) and renal impairment. Methods In this cross-sectional study with retrospective record review, 403 established gouty arthritis patients were recruited to determine the incidence of UGIB and associated factors among gout patients who were on regular nonsteroidal anti-inflammatory drugs (NSAIDs). Results The mean age of the 403 gouty arthritis patients was 55.7 years old and the majority (n = 359/403; 89.1%) were male. The incidence of UGIB among gouty arthritis patients who were on NSAIDs was 7.2% (n = 29/403). Older age (p < 0.001), diclofenac medication (p = 0.003), pantoprazole medication (p = 0.003), end-stage renal failure (ESRF) (p = 0.007), smoking (p = 0.035), hypertension (p = 0.042) and creatinine (p = 0.045) were significant risk factors for UGIB among the gouty arthritis patients in univariable analysis. Older age (p = 0.001) and diclofenac medication (p < 0.001) remained significant risk factors for UGIB among the gouty arthritis patients in multivariable analysis. Conclusions Age and diclofenac were significantly associated with UGIB among patients with gouty arthritis on regular NSAIDs, indicating that these factors increased the risks of developing UGIB in gout patients. Hence, these high-risk groups of gouty arthritis patients should be routinely monitored to avoid the potential onset of UGIB. Our data also suggest that diclofenac should be prescribed for the shortest duration possible to minimize the risk of developing UGIB in gout patients.

This study employed Bacillus spp. with α-amylase production isolated from Malaysian hot spring for domestic kitchen food waste treatment contained grains, vegetables, chicken and tuna that mimic the food waste discharge from domestic kitchens in Malaysian household. Results showed that Bacillus licheniformis HULUB1 and Bacillus subtilis SUNGB2 possess excellent amylolytic properties. Highest α-amylase activity was obtained when both isolates were cultivated at pH 6.0 and 65 °C with concentrations of 18.15 U/mL for HULUB1 and 22.14 U/mL for SUNGB2. Stability of α-amylase with significant levels of enzyme activity were recorded at 55–85 °C and pH 5.0–9.0. The extracted mixed α-amylase of HULUB1 and SUNGB2 showed greatest reduction were achieved at day 12 with 45% ± 0.03 solid content at 65 °C. While the mixed culture of HULUB1 and SUNGB2 displayed an enhanced effect on the food waste contents reduction with 43% ± 0.02 solid content at 45 °C after day 12. The findings showed that the combination of the two Bacillus spp. isolates possessed degradation of food wastes at faster rate than α-amylase. It was also pointed out that the standard food waste (SFW) and the treatment process assimilated for this study was suitable for the growth of Bacillus spp.

Vanishing lung syndrome (VLS) is a rare condition characterized by giant emphysematous bullae. It is frequently misdiagnosed as pneumothorax. We describe a case of a 30-year-old male who presented with shortness of breath, reduced effort tolerance, and pleuritic chest pain for three months. He was initially diagnosed with bilateral pneumothorax based on clinical examination and chest radiograph findings. However, further imaging with a high resolution computed tomography (HRCT) of the thorax confirmed bilateral giant emphysematous bullae. Our patient subsequently underwent video-assisted thoracoscopic surgery (VATS) and bullectomy. In this report, we discuss the clinical presentations, radiological features, and the management of VLS. We also highlight the differentiating features of VLS from a pneumothorax.

Pseudomonas aeruginosa is one of the main causes of nosocomial infections and is frequently associated with opportunistic infections among hospitalized patients. Kaempferol-3-O-(2′,6′-di-O-trans-p-coumaroyl)-β-D glucopyranoside (KF) is an antipseudomonal compound isolated from the leaves of the native medicinal plant Melastoma malabathricum. Herein, an RNA-seq transcriptomic approach was employed to study the effect of KF treatment on P. aeruginosa and to elucidate the molecular mechanisms underlying the response to KF at two time points (6 h and 24 h incubation). Quantitative real-time PCR (qRT-PCR) was performed for four genes (uvrD, sodM, fumC1, and rpsL) to assess the reliability of the RNA-seq results. The RNA-seq transcriptomic analysis revealed that KF increases the expression of genes involved in the electron transport chain (NADH-I), resulting in the induction of ATP synthesis. Furthermore, KF also increased the expression of genes associated with ATP-binding cassette transporters, flagella, type III secretion system proteins, and DNA replication and repair, which may further influence nutrient uptake, motility, and growth. The results also revealed that KF decreased the expression of a broad range of virulence factors associated with LPS biosynthesis, iron homeostasis, cytotoxic pigment pyocyanin production, and motility and adhesion that are representative of an acute P. aeruginosa infection profile. In addition, P. aeruginosa pathways for amino acid synthesis and membrane lipid composition were modified to adapt to KF treatment. Overall, the present research provides a detailed view of P. aeruginosa adaptation and behaviour in response to KF and highlights the possible therapeutic approach of using plants to combat P. aeruginosa infections.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a pathological accumulation of hepatic lipid closely linked with many metabolic disorders, oxidative stress and inflammation. We aimed to evaluate the hepatoprotective effect of bee bread on oxidative stress and inflammatory parameters in MAFLD rats. Twenty-eight male Sprague-Dawley rats were assigned into four groups (n = 7/group): normal control (NC), high-fat diet (HFD), bee bread (HFD + Bb, HFD + 0.5 g/kg/day bee bread) and orlistat (HFD + Or, HFD + 10 mg/kg/day orlistat) groups. After 12 weeks, the HFD group demonstrated significantly higher body weight gain, serum levels of lipids (TG, TC, LDL), liver enzymes (AST, ALT, ALP) and adiponectin, liver lipids (TG, TC) and insulin resistance (HOMA-IR). Furthermore, the HFD group showed significantly decreased antioxidant enzyme activities (GPx, GST, GR, SOD, CAT) and GSH level, and increased liver oxidative stress (TBARS, NO), translocation of Nrf2 to the nucleus, Keap1 expression and inflammation (TNF-α, NF-κβ, MCP-1) together with histopathological alterations (steatosis, hepatocyte hypertrophy, inflammatory cell infiltration, collagen deposition), which indicated the presence of non-alcoholic steatohepatitis (NASH) and fibrosis. Bee bread significantly attenuated all these changes exerted by HFD feeding. In conclusion, our results suggest that bee bread might have antioxidant, anti-inflammatory, anti-steatotic and anti-fibrotic effects that are beneficial in protecting liver progression towards NASH and fibrosis.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is an excessive buildup of liver lipids closely associated with various kinds of undesirable metabolic effects and oxidative stress. We aimed to investigate the protective and therapeutic effects of orlistat on metabolic syndrome and oxidative stress parameters in high-fat diet (HFD) induced-MAFLD rats. Twenty-four male Sprague-Dawley rats were randomly divided into four groups (n = 6/group), i.e., Normal control (N), HFD, HFD + orlistat (HFD + O) (10 mg/kg/day administered concomitantly for 12 weeks as a protective model), and obese+orlistat (OB + O) (10 mg/kg/day administered 6 weeks after induction of obesity as a therapeutic model) groups. After 12 weeks, the HFD group had significantly increased Lee obesity index, serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total cholesterol, triglyceride, low-density lipoprotein levels, liver total cholesterol and triglyceride levels, insulin resistance and non-alcoholic steatohepatitis (NASH) together with decreased serum high-density lipoprotein level. Additionally, the HFD group also showed increased Nrf2 translocation to the nucleus with high Keap1 expression and increased liver oxidative stress parameters. Orlistat significantly improved all these alterations in HFD rats. We demonstrated that orlistat might have protective and therapeutic effects against HFD-induced MAFLD rats by its activation on Nrf2 signaling pathway, which subsequently improved metabolic syndrome and oxidative stress parameters.

Objective: To investigate the properties of screw-bone interface of expansive pedicle screw (EPS) in osteoporotic sheep by micro-CT and histological observation.Methods: Six female sheep with bilateral ovariectomy-induced osteoporosis were employed in this experiment. After EPS insertion in each femoral condyle, the sheep were randomly divided into two groups: 3 sheep were bred for 3 months (Group A), while the other 3 were bred for 6 months (Group B). After the animals being killed, the femoral condyles with EPS were obtained, which were three-dimensionally-imaged and reconstructed by micro-CT. Histological evaluation was made thereafter.Results: The trabecular microstructure was denser at the screw-bone interface than in the distant parts in expansive section, especially within the spiral marking. In the non-expansive section, however, there was no significant difference between the interface and the distant parts. The regions of interest (ROI) adjacent to EPS were reconstructed and analyzed by micro-CT with the same thresholds. The three-dimensional (3-D) parameters, including tissue mineral density (TMD), bone volume fraction (BVF, BV/TV), bone surface/bone volume (BS/BV) ratio, trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp), were significantly better in expansive sections than non-expansive sections (P less than 0.05). Histologically, newly-formed bony trabeculae crawled along the expansive fissures and into the center of EPS. The newly-formed bones, as well as the bones at the bone-screw interface, closely contacted with the EPS and constructed four compartments.Conclusions: The findings of the current study, based on micro-CT and histological evaluation, suggest that EPS can significantly provide stabilization in osteoporotic cancellous bones. [ABSTRACT FROM AUTHOR]

Abstract Background Honey has been demonstrated to possess anti-inflammatory property. This is a randomized, controlled, open-label trial to determine the effects of 12-week honey oral supplementation on plasma inflammatory markers such as high sensitive C-reactive protein, interleukin-6 and tumor necrosis factor-α among chronic smokers. Methods/design A total of 32 non-smokers and 64 chronic smokers from Quit Smoking Clinic and Health Campus, Universiti Sains Malaysia participated in the study. Smokers were then randomized into 2 groups: smokers with honey group that received Malaysian Tualang honey (20 g/day daily for 12 weeks) and smokers without honey group. Blood was obtained from non-smokers and smokers at pre-intervention, and from smokers at post-intervention for measurement of the inflammatory markers. Results At pre-intervention, smokers had significantly higher high sensitive C-reactive protein than non-smokers. In smokers with honey group, tumor necrosis factor-α was significantly increased while high sensitive C-reactive protein was significantly reduced at post-intervention than at pre-intervention. Conclusion This study suggests that honey supplementation has opposite effects on tumor necrosis factor-α and high sensitive C-reactive protein indicating the inconclusive effect of honey on inflammation among chronic smokers which needs further study on other inflammatory markers. Trial registration The Trial has been registered in the Australian New Zealand Clinical Trials Registry: ACTRN12615001236583 . Registered 11 November 2015 (Retrospectively Registered).

Obesity is typically linked to oxidative stress and inflammation, which lead to vascular damage and initiate the progression of atherosclerosis. The aim of this study was to determine the anti-atherosclerotic effect of orlistat on obesity-induced vascular oxidative stress in obese male rats. Twenty-four male Sprague–Dawley rats were categorized into two groups: normal (Normal group, n = 6) and high-fat diet (HFD group, n = 12). After six weeks, obese rats in the HFD group were administered either with distilled water (OB group) or orlistat 10 mg/kg/day (OB/OR group) for another six weeks. The OB group had a significant increase in lipid profiles (total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL)) and decrease in high-density lipoprotein (HDL) level compared to the Normal group. The aortic antioxidants enzymes activities (superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR), glutathione S-transferase (GST), and catalase (CAT)) as well as total glutathione (GSH) and total antioxidant capacity (TAC) of the OB group were significantly decreased compared to the Normal group. Furthermore, pro-inflammatory atherosclerotic markers (tumour necrosis factor-alpha (TNF-α), vascular cell adhesion molecule-1 (VCAM-1), and intercellular cell adhesion molecule-1 (ICAM-1)) expressions were increased significantly, and anti-inflammatory marker (interleukin-10 (IL-10)) was decreased significantly in the OB group compared to the Normal group. Treatment with orlistat significantly improved lipid profile, increased antioxidant enzymes and expression of anti-inflammatory markers, and decreased the expression of the pro-inflammatory marker compared to the OB group. These findings may suggest the therapeutic effect of orlistat in attenuating the progression of the atherosclerotic stage in obesity.

Calamansi fruits (Citrus microcarpa) or musk lime is one horticulture crops has been known as beverage and food flavorings. This research aimed to determine the effect of 2,4-D and BAP on callus induction of explants calamansi fruits (Citrus microcarpa). Parameters observed is percentage of explants, time appeared callus, callus width, and texture of the callus. Research results and a growing percentage of the width callus explants were analyzed by ANOVA and a further test DMRT at 5% level. The next to appear callus timing parameters and texture of callus analyzed in description. The result shows that a combination of hormones D4B1 and D4B2 produces a callus emerged fastest of 3.3 days after culture. The highest percentage of callus formation that is 100% contained in the treatment of D2B0, D2B0.5-D4B0. The mean width of callus was highest in treatment D4B2with a width of 0.97 cm. Embryogenic callus resulting by treatment of D2B1, D2B2, and D3B0. However, the best a combination of hormones is treatment D2B2 (2 mg/l, 2,4-D, dan 2 mg/l BAP) producing embryogenic callus edvanced to suspension cultures.

Introduction: Little is known about the prevalence of hearing loss and the usefulness of self-reported hearing loss among older adults in Malaysia. Aim: We conducted a population-based study to investigate the prevalence of self-reported hearing problem and its relationship with audiometric hearing thresholds in older adults in Selangor, Malaysia. We also investigated demographic factors that were associated with the self-reported hearing loss. Materials and Methods: The participants were recruited from Selangor using multi-stage clustered sampling involving 324 participants aged between 60 to 88 years (68.3±5.9 years). All participants underwent a face-to-face interview and pure tone audiometry. Self-reported hearing loss was obtained using three questions. Results: The prevalence of self-reported hearing problems was 53.4%. This prevalence did not differ significantly among age group, gender, race and education level (p>0.05). Univariate and logistic regression analyses found that tinnitus and Pure Tone Average (PTA) of at least moderate hearing loss at 0.5 kHz to 4 kHz contributed significantly to the likelihood of self-reported hearing problem. Participants with tinnitus and participants with PTA of at least moderate hearing loss at 0.5 kHz to 4 kHz were twice as likely to report hearing problem than their counterparts. The questions yielded poor sensitivity in identifying at least mild loss and moderate sensitivity for at least moderate hearing loss. Conclusion: The present study highlights the need for a more effective self-report inventory or audiometry instrument that is less sensitive to background noise to better estimate hearing loss prevalence among adults in Malaysia.

This study was undertaken to determine the phenolic compounds and the anti-atherogenic effect of bee bread in high-fat diet (HFD)-induced obese rats. The presence of phenolic compounds in bee bread was determined by liquid chromatography−mass spectrometry. Thirty-two male Sprague Dawley rats were divided into four groups, (n = 8/group); i.e., Normal (N), HFD (high-fat diet), HFD + BB (high-fat diet and 0.5 g/kg/day bee bread), and HFD + O (high-fat diet and 10 mg/kg/day orlistat) groups. After 6 weeks of the experiment, rats were sacrificed. Five phenolic compounds were identified in bee bread; namely, caffeic acid, ferulic acid, kaempferol, apigenin, and isorhamnetin. Bee bread significantly reduced Lee obesity index and levels of total cholesterol (TC), low-density lipoprotein (LDL), fatty acid synthase (FAS) activity, atherogenic index, oxidised-LDL (oxLDL), and malondialdehyde (MDA), and significantly increased aortic antioxidant activities, such as those of superoxide dismutase (SOD) and glutathione peroxidase (GPx). Adipocyte sizes were found to be smaller in the HFD + BB group compared to the N group, and en face aortas showed an absence of atherosclerotic plaque in rats supplemented with bee bread. These changes might suggest an anti-atherogenic effect of bee bread in HFD-induced obese rats via its antioxidant and hypocholesterolaemic properties.

The Malaysian Government has set an ambitious target to achieve a higher penetration of Renewable Energy (RE) in the Malaysian energy mix. To date, Malaysia has approximately 2% of its energy coming from RE generation sources compared to the total generation mix and targets achieving 20% penetration by 2025. The current energy mix for Malaysia power generation is mainly provided by natural gas and coal. The discussion will cover the traditional sources of generation including natural gas, coal and big hydro stations. In addition, the paper will cover in depth the potential of RE in the country, challenges, and opportunities in this sector. This study can give an initial evaluation of the Malaysian energy industry, especially for RE and can initiate further research and development in this area in order to support the Government target to achieve RE target of 20% by 2025.

Background Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published. Methods Sixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed. Results The results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18-hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups. Conclusions In conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.