Abstract Tropical peatlands in Indonesia are very large, covering an area of about 13.4-14.9 million hectares. Kubu Raya District, West Kalimantan, is known to have significant natural resources and large regions of peatland. This research aims to estimate the thickness and volume of peat soil in the Rasau Jaya and Sungai Raya sub-districts of Kubu Raya Regency. This research uses the Ground Penetrating Radar (GPR) method, using the Plug-In Cobra GPR SE70 tool with a frequency of 80 MHz. This research applies 23 tracks and validation by three drill points, consisting of nine tracks in Sungai Raya District and 14 tracks in Rasau Jaya District. GPR data is processed through several processes: static correction, dewow, Butterworth bandpass, background removal, gain, subtracting average, and horizon picking. The results showed that the subsurface electromagnetic wave propagation speed at the research location was 0.026 m/ns, having a peat thickness of 0.8-4.2m. The deepest peat layer is in the east, having a thickness of 3.8-4.2m, while the shallowest peat layer is in the west, having a thickness of 0.8-1.1m. The results also show that the volume of peat in the research location is 4.8×107 m3
Abstract The Belum-Temengor Forest Complex (BTFC) is a recognised biodiversity nexus, home to numerous endemic and threatened species. This forest complex includes diverse ecosystems, ranging from lowland dipterocarp forests to highland areas, which are pivotal in ecological balance and local climate processes. The forest has been designated as an Environmentally Sensitive Area (ESA) Rank 1 due to its unique environmental value, highlighting the need for rigorous protection and conservation measures. The current study provided a comprehensive analysis of the existing literature on the BTFC, covering vital aspects such as floral composition, focusing on several important species, ecological role, ecotourism, and the interrelationships among the Orang Asli community within this forest complex. The findings revealed that the diverse floral species composition within the forest complex significantly enhances the ecotourism potential and supports the socio-economic development of the Orang Asli communities. Additionally, the current study highlighted the crucial ecological role of the forest and addressed several threats, including deforestation and habitat loss.
Abstract This study aims to examine the impact of the Service-Learning approach on the engineering education system and student learning. The study is conducted through the example of a specific implementation of this approach, namely the “Smile project,” a collaborative initiative between universities in Morocco and South Korea. This study also provides valuable insights and recommendations to further develop this educational implementation. To assess the effectiveness of the program in enhancing student learning, the study uses pre- and post-questionnaires administered to the participating students. The results of this analysis reveal a strong positive effect of engineering service-learning as a learning approach, improving both technical and interpersonal skills of engineering students. The impact on these skills, however, varies among individuals.
Abstract Rauvolfia vomitoria Afzel has attracted significant research interest due to its multiple health benefits. Its antioxidant properties are important in preventing oxidative stress, cancer, heart problems, and neurological disorders. This study compares the antioxidant capacity of R. vomitoria leaf extract in both hot and cold water. Standard methods were used to prepare leaf extracts in both hot and cold water, which were subjected to different antioxidant assays. The hot water leaf extract had a better capacity to snare free radicals produced by stable DPPH's free radical at 50% inhibition concentration (3.07 ± 0.54 mg/ml) than the cold water leaf extract (9.82 ± 0.01mg/ml). The nitric oxide inhibitory capacity of R. vomitoria at 50% inhibition concentration in cold and hot water leaf extract (3.64 ± 0.38 and 4.24 ± 0.11) showed no significant difference. The hot water leaf extract had higher ferric-reducing antioxidant power (IC50 of 7.21 ± 0.07 mg/ml) than the cold water extract (10.85 ± 0.50 mg/ml). The hot water leaf extract showed a higher total antioxidant capacity (IC50 of 6.01 ± 0.21 mg/ml) than the cold water extract (9.01 ± 0.07 mg/ml). These antioxidant evaluations show that R. vomitoria hot water leaf extracts were superior to cold water leaf extracts as antioxidants and free radical scavengers. The findings show that R. vomitoria's hot-water extract has greater antioxidant activity than its cold-water extract.
Abstract Indonesian traditional herbal medicines (Jamu) are prohibited from containing active pharmaceutical ingredients (APIs). Nevertheless, reports indicate that some hyperuricemia jamu products still contain such substances, including paracetamol This study aimed to optimize High-Performance Liquid Chromatography (HPLC) conditions and to validate an analytical method for the determination of paracetamol in jamu for hyperuricemia obtained from Pasar Besar, Malang City. Response Surface Methodology (RSM) combined with a Box–Behnken Design (BBD) was employed to optimize the HPLC conditions. The investigated parameters were the methanol proportion in the mobile phase (X₁, 30–90% v/v), flow rate (X₂, 0.5–1.0 mL/min), and column temperature (X₃, 20–30 °C). The evaluated response variables included peak area (Y₁), resolution (Y₂), tailing factor (Y₃), and theoretical plate number (Y₄). The optimal HPLC conditions consisted of 30% v/v methanol in aquadest, a flow rate of 1.0 mL/min, and a column temperature of 25.18 °C. Method validation demonstrated satisfactory selectivity (λmax 245 nm; paracetamol retention time ± 3.33 min), linearity (r² = 0.99), limit of detection (LOD) of 1.51 ppm, and limit of quantification (LOQ) of 5.03 ppm. The method also showed acceptable accuracy (101.75–104.61%) and precision (0.53–1.59%), fulfilling the acceptance criteria. Paracetamol was detected in one jamu sample for hyperuricemia at an average concentration of 5.08% w/w. This finding indicates a violation of the Regulation of the Minister of Health of the Republic of Indonesia No. 7 of 2012 concerning the registration of traditional medicines.
Abstract This study aims to replace soybeans, which pose allergy risks, with black turtle beans as a fermentation substrate for natto production. Bacillus subtilis MS05, known for its production of the fibrinolytic enzyme nattokinase, was employed to determine the optimal fermentation conditions. This was achieved through a multifaceted approach, incorporating one-factor-at-a-time experiments, a Plackett-Burman experimental design, as well as a response surface methodology with central composite design. The study reported the highest fibrinolytic activity at 418.32 FU/mL, which is equivalent to the nattokinase enzyme activity found in 5g of natto. This is sufficient to meet the daily nattokinase requirement of an adult consuming 25g of natto. Key factors that significantly influenced the fermentation process were identified as a peptone concentration of 2.8%, a bacterial density of 10⁴ CFU/g of Bacillus subtilis, an initial pH of 5.5, and a fermentation duration of 33 hours. Additionally, natto produced from black turtle beans exhibited remarkable antioxidant activity, as indicated by a DPPH activity of 81.21 µg/mL. These findings highlight the significant potential of black turtle bean-based natto in enhancing fibrinolytic activity and effectively combating free radicals. These attributes contribute to the treatment of atherosclerotic blood clots and hold promise for improving overall human health by nutritional interventions.
Abstract Mangroves, the world’s most productive ecosystem, harbour thousands of species of phytoplankton. Phytoplankton are the responsible microorganisms allowing mangroves to serve the ecosystem services. Unfortunately, this ecosystem is currently at threat due to various reasons. A study was carried out in a mangrove ecosystem at Kerteh River, Terengganu. Kerteh River is currently facing metal pollution problem that caused by the rapid industrialization. This problem is at high potential to directly impact the composition and abundance of phytoplankton. Therefore, this study was planned to determine the spatial species diversity of phytoplankton at three different stations at selected Kerteh River mangrove area. One off sampling was carried out for two days in August 2019. Three stations were established along the selected Kerteh River area based on the stations exposure to anthropogenic activities. Fifty-six phytoplankton species of four divisions were recorded in this present study. Forty-five species were of Bacillariophyta followed by four species of Chlorophyta, five species of Dinophyta and one species of Cyanophyta. The ranges of phytoplankton diversity indices (H’) and equitability (J’) at Kerteh River were 2.60 to 3.0 and 0.75 to 0.80, respectively. A One-Way Analysis of Variance (ANOVA) shows a significant different in the diversity of phytoplankton between stations (p<0.05). Chaetoceros curvisetus was the species with the highest relative abundance at Station 1 and 3, while at Station 2, it was the Frustulia vulgaris. There were five species of Dinoflagellate recorded at the study site, the Ceratium sp, Dinophysis sp., Protoperidinium pallidum, Protoperidinium sp1 and Protoperidinium sp2. The preliminary record on the phytoplankton species at Kerteh River hopefully can provide insight on the impact in the shift made by current and emerging anthropogenic activities at the area.
Abstract Tarantulas play a crucial role in maintaining ecological balance by regulating insect populations. However, little is known about the soil preferences and burrow structures of tarantulas in Malaysia. This study aims to determine the soil preference as well as the burrow structure of Coremiocnemis cunciularia and Chilobrachys andersoni from Penang Island. The soil characteristics of the soil samples collected around the burrows of Coremiocnemis cunciularia (n = 30) and Chilobrachys andersoni (n = 30) were determined using soil texture analysis. The measurements and burrow structures from adults and juveniles of Coremiocnemis cunciularia and Chilobrachys andersoni were determined. It was revealed that the moisture content and clay percentage in the soil samples around burrows of Chilobrachys andersoni and Coremiocnemis cunicularia were significantly different. Meanwhile, there is some variation in the structure and measurements of the burrows of the two tarantula species. The findings in this study could be useful for the conservation works and habitat management of tarantulas on Penang Island.
Abstract Tubifex tubifex Müller, 1774 is an oligochaete that is extensively dispersed, in particular in freshwater ecosystem and plays an important role in the ecosystem. It is one of natural or live feed for aquatic organism in the nature or cultivation media. Furthermore, T. tubifex could be a reasonable living being for the inquire about of the organic impact of different contaminations due to its capacity to decompose matter as well as accumulate the metals or chemical pollutants. This review aimed to elaborate the information about the biology of T. tubifex and its role, focused on its ability as decomposer in freshwater ecosystem. In the arrangement of this paper, many relevant scientific articles were cited. This paper examined the biology of T. tubifex (i.e., morphology, chaetae, segmentation, respiratory, reproduction, and habitat of Tubifex) and also the role of Tubifex as bioremediator. This review informed that Tubifex has reddish color due to the presence of erythrocruorin. As a group of clitellates, Tubifex has clitellum at segments X, XI, and XII. Furthermore, as a group of oligochaetes, it has chaetae that play important role for burrowing, hooking to the substrate, swimming, crawling, and bioturbating. Tubificidae have capability of autotomization (autotomy) and regeneration of its missing body part. T. tubifex spends its whole life cycle within the substrate with head down within the substrate, whereas part of its posterior may extend over the water column-substrate interface. T. tubifex develop a mixed reproductive strategy, a self-fertilization or parthenogenesis (pseudogamy), and hermaphrodite. Tubifex is a meiobenthic species of aquatic worm and an important key for organic matter decomposition, heavy metal or chemical substances reduction and detoxification. It can do vermicomposting to organic matter and also accumulate chemical substances by its metabolic compound like superoxide dismutase enzyme, catalase enzyme, carboxylesterase enzyme, glutathione-S-transferase enzyme, and metallothionein enzyme.
Abstract Proteus mirabilis (P. mirabilis), known for its swarming motility, is a facultatively anaerobic, rod-shaped, Gram-negative bacterium. It forms extended swarmer cells as well as moves in a bull’s-eye formation. Proteus mirabilis significantly causes catheter-associated urinary tract infections through virulence components including flagella, fimbriae, hemolysin, urease, and proteases. Flagella-related motility allows P. mirabilis to infect the urinary system. The flagellum, composed of about 20 proteins, has a body that penetrates the cell wall, a curved hook, and a filament extending several micrometers. Previously, we knocked out PmiR-137, anticipated to modulate flhDC, which involve in the central transcriptional activator for flagellum formation and performed a differential gene expression study. We discovered npcRNA PmiR-31, expected to influence fliZ production via the TargetRNA web tool. We analyzed PmiR-31 expression under various stress and growth phases via northern blot. The PmiR-31 was highly expressed in stress conditions but not in the mutant strain. Since FliZ regulates flagella assembly, npcRNA PmiR-31 may repress fliZ translation, preventing flagella synthesis and promoting biofilm formation to evade the immune system.
Abstract With the increase in maternal age and the impact of environmental stress, the decline in ovarian reserve and oocyte quality has emerged as a primary cause of infertility. Dysfunction of cytoskeletal proteins plays a central role in this process. This study aims to examine the differential expression and regulatory functions of cytoskeleton-associated long non-coding RNAs (lncRNAs) during the development of mouse oocytes at the germinal vesicle (GV) and metaphase II (MII) stages. This study employed bioinformatics analyses and machine learning techniques to analyze publicly accessible data from the Gene Expression Omnibus (GEO) database, which comprised 13 samples of Germinal Vesicle (GV) stage oocytes and 15 samples of Metaphase II (MII) stage oocytes. Differential expression analysis, weighted gene co-expression network analysis (WGCNA), and interaction network construction were performed to screen for lncRNAs closely related to oocyte development. A total of 338 differentially expressed lncRNAs (DE-lncRNAs) with statistical significance were identified, including 136 upregulated and 202 downregulated lncRNAs, indicating their potential roles in the transition from the GV to the MII stage during oocyte development. WGCNA further identified modules strongly correlated with cytoskeletal proteins by integrating these results with the differentially expressed lncRNAs. A total of 47 candidate lncRNAs were shortlisted. Subsequently, LASSO regression and random forest algorithms were applied to identify six key lncRNAs from the candidate set. Combined with miRNA prediction and target gene analysis, a lncRNA-miRNA-mRNA regulatory network was constructed, revealing that these key lncRNAs may indirectly regulate downstream target gene expression through specific miRNAs. Furthermore, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses indicated that these key lncRNAs are primarily involved in cytoskeletal remodeling, cell proliferation, and differentiation, and may play critical roles in follicle structure formation and oocyte development. This study systematically mapped the regulatory network of lncRNAs during oocyte development and elucidated the lncRNA-miRNA-mRNA interactions. The results emphasize the key roles of lncRNAs in cytoskeletal remodeling and oocyte maturation, providing valuable insights for the diagnosis and treatment of ovarian disorders.
Abstract Platelet transfusion refractoriness is a less-than-expected increase in platelet count following platelet transfusions. We report a case of platelet transfusion refractoriness with identification of anti-HLA class I alloantibody. In patients with thrombocytopenia, even when multiple established aetiologies are present, it is essential to recognise platelet transfusion refractoriness and to perform further laboratory investigations, including platelet immunology test. This approach enables identification of additional contributing factors to thrombocytopenia and clarification of the underlying causes of platelet refractoriness, thereby guiding appropriate therapeutic strategies.
Abstract Lupus Nephritis (LN) is a complication of Systemic Lupus Erythematosus affecting the kidney. The purpose of this study was to identify signalling pathways and hub genes involved in the pathogenesis of LN. Methods: The mRNA expression profiles of LN were obtained from the Gene Expression Omnibus database, and differentially expressed genes (DEGs) were identified using the online tool GEO2R. Enrichment analysis was conducted in DAVID. The Protein-Protein Interaction network of DEGs was constructed in STRING, and hub genes were identified with Cytoscape. The hub genes were validated using differentially expressed proteins (DEPs) from proteomics data to identify potential biomarkers for LN. Results: A total of 138 DEGs were identified, primarily associated with immune response, neutrophil chemotaxis, and antimicrobial humoral immunity. In KEGG analysis, the NOD-like receptor signalling pathway and the Cytokine-cytokine receptor interaction pathway were mainly involved. Nine hub genes of LN, including Ifit1, Ifit3, Ifih1, Ifi44, Irf7, Irf9, Oasl1, Stat1, and Usp18 were identified. Conclusion: Ifi44 and Stat1 were expressed in both DEGs and DEPs. Ifi44 and Stat1 may be potential biomarkers and therapeutic targets for LN.
Abstract Alzheimer's disease (AD) is a common neurodegenerative disorder marked by progressive cognitive decline. Due to its effects on cognitive functioning and hippocampal integrity, the combined treatment of D-galactose (D-gal) and Aluminium chloride (AlCl3) in rats is a widely used model for producing AD-like symptoms. Previous studies demonstrated that Cannabidiol (CBD) exhibits neurotherapeutic effects. This study examines the efficacy of CBD in reducing cognitive deficits and brain ultrastructural damage induced by D-gal and AlCl3. Male Wistar rats were treated with D-gal (60 mg/kg body weight/day) and AlCl3 (200 mg/kg body weight/day) for 10 weeks to induce AD-like symptoms, followed by CBD administration at doses of 20, 40, and 80 mg/kg/day. Donepezil (1 mg/kg body weight/day) served as a positive control. Cognitive performance was evaluated using the modified elevated plus maze and T-maze spontaneous alternation tests. Ultrastructural changes in the hippocampus were examined using transmission electron microscopy. Rats exposed to D-gal and AlCl3 exhibited significant cognitive impairments, including deficits in spatial learning and memory, as well as hippocampal ultrastructural damage. The results indicated that D-gal and AlCl3 exposure produced notable cognitive deficits and structural alterations in the hippocampus. Administration of CBD at all doses significantly enhanced cognitive function and reduced pathological changes, providing protective effects comparable to donepezil. These findings support CBD's potential as a neurotherapeutic compound for mitigating cognitive decline and hippocampal damage associated with AD.
Abstract A 64-year-old man presented with progressively worsening difficulty in breathing and was subsequently diagnosed with immunoglobulin light chain (AL) amyloidosis. However, he was keen to seek a second opinion, causing a delay in initiating definitive treatment. His clinical manifestations included heart failure, chronic diarrhoea, symmetric lower extremity peripheral neuropathy, and autonomic neuropathy (postural hypotension). As he was non-transplant eligible and had financial constraints, he was initially treated with conventional chemotherapy [two cycles of cyclophosphamide + thalidomide + dexamethasone, followed by seven cycles of melphalan + prednisolone (MP)]. Throughout his disease course, he experienced chronic diarrhoea and profound oedema of lower limbs. He had to relocate to his son’s residence in Kuala Lumpur to enable frequent and regular hospital visits. He had impaired health-related quality of life (HRQoL); however, he had excellent family support. After nine cycles of conventional chemotherapy, the optimal response was not achieved. Bortezomib was added to MP therapy [bortezomib + melphalan + prednisolone (VMP) regimen]. Following three cycles of VMP, he achieved complete haematologic response (CR), resulting in symptomatic improvement and his eventual return to his hometown. He continued the same treatment regimen to control the disease. His hospital admissions decreased, and his HRQoL improved, although no organ response was noted. Three years later, he developed decompensated cardiac failure and passed away. His overall survival was five years and two months. This case report highlights that achieving CR leads to prolonged overall survival and improved long-term clinical outcomes, including HRQoL.
Abstract This study aimed to provide preliminary data on the safe use of liquorice extracts for herbal product consumers. Female Sprague Dawley rats received a single-day treatment with liquorice extract (50–2000 mg/kg) or distilled water (control). Liver and kidney functions were evaluated through blood biochemical analysis, gross, and histological evaluation. This animal study adhered to the OECD Test Guideline 423. Fifteen female SD rats, aged 16 weeks, were randomly assigned to five groups (n = 3). The control group received distilled water, while treatment groups T1, T2, T3, and T4 were administered liquorice extract at doses of 2000, 200, 100, and 50 mg/kg via oral gavage. Body and organ weights (liver, kidney, heart) were measured. Blood samples were collected to assess serum biochemical markers, including alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), creatinine, and urea levels. Data were analysed using Dunnett’s tests, with p < 0.05 denoting statistical significance. No significant changes in body or organ weights occurred across groups. Liquorice extract had no effect on ALT or GGT. Serum creatinine decreased (p < 0.05) at 200 mg/kg, and serum urea decreased at 50 mg/kg compared with controls. A single-day liquorice extract treatment (50–2000 mg/kg) was safe and caused no hepatic or renal toxicity in female SD rats.
Abstract Diabetes mellitus, once primarily affecting the elderly, is now increasingly diagnosed in younger individuals due to poor lifestyle habits. Early detection through health screening is essential for effective management. A government agency that has conducted diabetes screening programs since 2013 launched its third initiative, aiming for an 80% detection rate among screened participants using HbA1c (cutoff ≥ 6.3%), rather than reflecting national diabetes prevalence. This cross-sectional study evaluated the program’s effectiveness in detecting diabetes among Malaysian adults aged 40 to 59 in Klang Valley. A total of 188 participants attended free screenings at registered clinics between September and December 2023. The cohort included 47.35% men and 52.65% women, with 41.5% Malays, 40.4% Chinese, 14.4% Indians, and 3.7% from other ethnic groups. HbA1c levels ≥ 6.3% were found in 27.12% of participants, with the highest prevalence among Indians (33.3%), followed by Malays (29%), Chinese (23.68%), and others (14.28%). Statistical analysis (ANOVA) showed no significant association between HbA1c levels and age, gender, or ethnicity (p = 0.188). The program did not meet its 80% detection target, suggesting that alternative screening approaches, including revised diagnostic criteria or additional risk assessments, may be needed to improve diabetes detection and intervention efforts.
Abstract Fibrosing obliterative appendicitis is an uncommon inflammatory condition of the appendix that can lead to significant diagnostic challenges, particularly in younger patients. In a patient presenting with abdominal pain at the emergency department, appendicitis must be considered and ruled out. However, due to various causes of abdominal pain, the diagnosis of appendicitis may be challenging. Therefore, thorough history taking and a careful clinical examination are essential for identifying appendicitis and ensuring prompt treatment. This study describes a young patient who presented with a complaint of right lower abdominal pain for the past 4 days. A 14-year-old male presented to the emergency department with right lower abdominal pain, without associated symptoms. He had a similar episode three months earlier and was treated conservatively. Ultrasound suggested mesenteric lymphadenitis. Diagnostic laparoscopy was initially performed, but was then converted to open surgery due to an invisible appendix. The procedure revealed an inflamed, slender appendix adhering to the cecum with enlarged mesenteric lymph nodes. Appendectomy and lymph node excision were performed. Histopathology confirmed fibrosing obliterative appendicitis with reactive lymphadenitis. The patient was discharged after two days in stable condition. This case highlights the diagnostic challenge of chronic appendicitis in paediatric patients. Diagnostic laparoscopy proved valuable in identifying fibrosing obliterative appendicitis, allowing for effective surgical intervention.
Abstract Naphthalene (NP), a widely used polycyclic aromatic hydrocarbon, is present in various commercial products and environmental pollutants. Despite its established toxicity, its impact on neuronal integrity and behavior remains relatively underexplored. This study investigates oral NP-induced behavioral and neuronal alterations in Sprague Dawley rats. Twenty-five animals were divided into five groups and oral NP was administered at varying doses (200 mg/kg and 400 mg/kg) for 28 days, with post-treatment evaluations up to 42 days. Behavioral assessments using the open field test revealed initial hyperactivity, followed by a progressive decline in locomotion and increased anxiety-related behavior in high-dose groups. Cresyl violet staining of the basolateral amygdala showed significant neurodegeneration, with pyramidal neuronal damage more pronounced in high-dose groups. Statistical analysis was conducted using one-way ANOVA, and post-hoc Duncan's test was applied to confirm a dose-dependent decrease in neuronal viability (p < 0.05). Post-treatment observations indicated partial behavioral recovery but no significant reversal of neuronal damage. The findings suggest that oral NP exposure induces anxiety-associated behavioral changes and neurotoxicity in the amygdala, potentially affecting emotional regulation. Further investigation is required to assess the long-term effects of oral NP exposure on brain function.
Abstract Sustaining the market for biosimilars is key to securing the long-term benefits from biosimilar medicines. Policy can influence the achievement of those elements that contribute to the sustainability of biosimilars. Despite being the first country to implement regulatory guidelines for the approval and marketing of biosimilars, the availability and adoption of biosimilars in Malaysia remain suboptimal. This study aims to create the roadmap of policy elements that influence the sustainability of the biosimilar market in Malaysia. The study searched and reviewed articles in PubMed, Google Scholar, National Library of Medicine from 1/1/2003 to 14/04/2024. A total of 3469 results were found, with PubMed contributing 39 records (n=39), Google Scholar contributing 3074 records (n=3074), and the National Library of Medicine contributing 356 records (n=356). The biosimilars policy framework and sustainability measures were adopted from IQVIA Country Scorecards for Biosimilar Sustainability. After eliminating duplicates and applying selection criteria, 20 articles were chosen for review. The selection was justified based on relevance to the five policy domains: regulatory environment and clinical guidelines, awareness and education, incentives, pricing rules and dynamics, and purchasing mechanisms. The 20 selected papers were categorized into five main domains: regulatory environment and clinical guidelines, awareness and education, incentives, pricing rules and dynamics, and purchasing mechanisms. The analysis revealed positive developments in regulatory compliance and clinical guidelines, pricing regulations, and purchasing mechanisms. However, challenges were identified in the areas of awareness and education, pricing rules and dynamics, and incentives. Awareness and education challenges were primarily attributed to limited pharmacist training and physician skepticism regarding biosimilars. Additionally, the absence of strong financial incentives and limited patient education hindered adoption. The "single-winner tendering system" constrained market diversity, restricting competitive pricing. The literature review emphasizes the need for setting up specific prescription targets, promoting competition, and offering incentives to biosimilar manufacturers to increase market appeal. Furthermore, it is critical to enforce strict quality standards for the incorporation of tenders and align the registration requirements with global standards. Education for pharmacists and continuous training for healthcare practitioners are also essential. In Malaysia, these steps are crucial in ensuring the affordability and accessibility of biosimilars. Improving these policy components could help Malaysia create a competitive biosimilar market, increase access to affordable treatments, and eventually raise the standard of healthcare service.
