INTRODUCTION: Malaysia was hit by one of the biggest waves of COVID-19 in year 2021, the worst-case morbidity and mortality since the pandemic started in 2020. Hospital Sungai Buloh (HSB), Selangor was the first hospital designed to treat COVID-19 cases only and was the referral centre for COVID-19 in the Klang Valley, hence all pregnant patients with COVID-19 in Selangor was referred here for treatment and care. This study aims to describe the characteristics and outcomes of pregnant women with COVID-19 admitted to HSB, and to identify the risk factors associated with severe outcomes. MATERIALS AND METHODS: This study is a single centre, retrospective cohort study whereby electronic records of pregnant patients with COVID-19 admitted to HSB from May to August 2021 were searched and data on sociodemographic and clinical characteristics, management, complication and outcomes of the mother and foetal were retrieved. RESULTS: Out of 282, 66 women had severe covid-19 (stage 4 &5) and 216 had non-severe COVID-19 (stage 1-3). We found that pregnant patients with severe COVID-19 infection are more likely to be obese, have lower absolute lymphocyte counts and higher C-reactive protein (>50) on admission, and higher day of illness on admission. CONCLUSION: Severe COVID-19 resulted in longer hospital stay, associated with higher disease related complications and adverse maternal and foetal outcomes. However, vertical transmission is rare although possible in COVID-19. Our study provides a valuable local data from a single COVID-19 centre in Malaysia
Skeletal muscle is the principal site of postprandial glucose disposal, and its exercise-stimulated glucose uptake is a cornerstone of metabolic health. This process depends on the glucose transporter GLUT4, which is regulated by both insulin- and contraction-stimulated pathways. Understanding exercise-driven GLUT4 dynamics is crucial for combating insulin resistance and type 2 diabetes. Over the past decades, research has progressed from descriptive physiology to a mechanistic framework, identifying key insulin-independent regulators such as AMPK, Rab GTPases, SNAREs, Rac1, and redox mediators. Emerging methodologies, including high-resolution imaging, quantum dot tracking, and proteomics profiling, have provided insight into vesicle docking, fusion, and signalling convergence. Comparative exercise studies reveal modality-specific effects (e.g., HIIT) and that regulation varies by age, sex, and metabolic status, highlighting the need for population-specific approaches. Nevertheless, important questions remain: the kinetics of GLUT4 exocytosis and endocytosis in human muscle remain incompletely defined, and the integration of redox signalling with canonical kinases such as AMPK and CaMKII is poorly understood. Moreover, most mechanistic insights are derived from rodent models or young male subjects, limiting generalisability to elderly, female, or insulin-resistant populations. Addressing these gaps requires translational studies combining advanced imaging, CRISPR reporters, and molecular phenotyping with human exercise interventions. Integrating exercise with pharmacological or nutritional strategies may also unlock synergistic effects on glucose regulation. In conclusion, GLUT4 sits at the nexus of exercise biology and metabolic disease. Elucidating its regulation across diverse populations is pivotal for advancing precision exercise medicine and developing targeted interventions for insulin resistance and type 2 diabetes.
Twin molar pregnancy refers to the coexistence of a complete or partial hydatidiform mole alongside a foetus. A complete hydatidiform mole with co-existing foetus (CHMCF) is an exceptionally rare obstetric phenomenon, with an incidence of approximately 1 in 20,000 to 100,000 pregnancies. Owing to its rarity, no standardized management guidelines currently exist. We report a case of a 33-year-old woman, G5P4, diagnosed with CHMCF at 15 weeks gestation, who developed severe maternal thyrotoxicosis and rapid uterine enlargement necessitating termination of pregnancy for maternal safety. Following termination of pregnancy, she was monitored closely with beta-hCG surveillance due to the potential risk of gestational trophoblastic neoplasia. This case highlights the diagnostic dilemma, as well as challenges of management and post-treatment surveillance in CHMCF. Early diagnosis and multidisciplinary care are essential for optimal maternal outcomes.
Spirulina, a small blue-green algae that lives in warm, alkaline seas, is one of the world's oldest life forms. With century-old history, this nutrient-rich organism has received a lot of interest in recent years for its possible health benefits and sustainable production practices. Studies have indicated its antioxidant, anti-cancer, and anti-inflammatory qualities are contributed by its bioactive compounds, mainly phycocyanin. Other compounds or elements include phycocyanobilin, carotenoids, unsaturated fatty acids, selenium, and amino acids. Breast cancer is one of the major causes of cancer related death in women. As some of the cancer therapies are highly associated with side effects, nutraceuticals such as Spirulina could be an alternative therapeutic intervention. Although some research has been conducted to investigate the anti-breast cancer effects of Spirulina in the past, its mechanism of action is not entirely understood. Previous studies suggest that it may trigger apoptosis and autophagy via modifying signalling pathways such as NF-κB and Bcl-2/Bax ratio. It also has anti-proliferative properties, inhibits cell migration, causes cell cycle arrest, and lowers cancer cells' capacity to form colonies. Phycocyanin has been shown to produce reactive oxygen species (ROS) and down-regulate anti-apoptotic molecules, which contribute to its anticancer capabilities. These findings show that Spirulina fights cancer by targeting a variety of cellular mechanisms involved in carcinogenesis. While these data imply potential benefits, more clinical trials and research into the exact mechanisms of Spirulina in cancer treatments are needed to fully demonstrate its efficacy in treating breast cancer in humans.
Hypertensive disorders of pregnancy (HDP) is a common condition in pregnant women affecting 5% to 10% of pregnancies worldwide. Women who have had HDP are at a higher risk of developing cardiovascular diseases (CVD) earlier in life compared to those who remained normotensive during pregnancy. HDP is associated with a significant increased risk of early-onset of CVD particularly hypertension and stroke, and this can lead to maternal mortality. Non-coding RNAs (ncRNAs) have been linked to HDP, particularly the long non-coding RNA (lncRNA), microRNA (miRNA), and circular RNA (circRNA). This scoping review identifies the most significant ncRNAs involved in predicting CVD in HDP. The protocol by Arksey and O’Malley was used in this scoping review. The steps were carried out in a systematic manner, including the identification of research questions, identification and selection of relevant studies, data charting and collating, summarizing the data, and reporting the findings. Multiple databases were searched for data collection, including Semantic Scholar, Scopus, PubMed Central, and Science Direct. In all thirty-one relevant studies were explored in this review. This review demonstrates the types, models, methodologies, and descriptions of non-coding RNAs associated with HDP. This review highlights that non-coding RNAs play a key role in predicting heart disease linked to high blood pressure in pregnancy by influencing blood vessels, inflammation, and stress, thus emphasizing their potential as early markers and the need for further study.
INTRODUCTION: Dementia progressively impairs cognitive abilities and negatively affecting communication between people with dementia (PWD) and their caregivers. This study explored caregivers' experiences in communicating with PWD. MATERIALS AND METHODS: This qualitative study received ethical approval from Universiti Kebangsaan Malaysia (JEP-2024-266). Sixteen family caregivers of PWD were purposively recruited from the Psychiatric Clinic, Occupational Therapy Unit, and Speech Therapy Unit at a public university hospital. Semi-structured face-to-face interviews were conducted individually, lasting 30-40 minutes, and were recorded via Microsoft Teams. The transcripts were analysed using thematic content analysis. Coding reliability achieved 81.33% agreement, and discrepancies were resolved through discussion. RESULTS: Two main themes were identified: Communication Challenges (CC) and Strategies to Support Communication (SSC). The CC theme comprised of four subthemes: cognitive deficits, other PWD-related factors, communication difficulties, and impacts on caregivers' personal lives. The SSC theme comprised of three subthemes: comprehensive support, active engagement, and the use of communication aids. Communication breakdowns, behavioural issues, coexisting health conditions, and limited family support contributed to caregiver stress, whereas memory support, emotional reassurance, cognitive stimulation, and multimodal communication strategies improved interaction. CONCLUSION: Caregivers' wellbeing is affected by the cognitive and behavioural challenges of PWD as well as the availability of family support. External support, engagement activities, and communication aids may enhance caregiver-PWD interaction and strengthen social connections. The findings highlight the need for culturally tailored interventions and caregiver training programs to improve communication experiences and overall quality of life for both caregivers and PWD.
Nursing education has undergone a significant transformation as a result of artificial intelligence(AI). Chatbots, specifically ChatGPT, have emerged as vital AI technologies within the nursing domain as it is a computer program designed to simulate human conversation through text or voice interactions. This study aims to conduct a bibliometric analysis to gain insights into the publication trends, citation impact, and thematic evolution in nursing education and practice concerning ChatGPT and chatbots. A comprehensive bibliometric analysis was performed using VOSViewer, concentrating on citation networks for data analysis and visualisation. A review of LENS.org identified 344 relevant research publications regarding chatbots and ChatGPT within the nursing discipline, all of which were utilised in the study. The study examined various aspects, including types of publications, prominent authors, leading journals, participating nations, institutions, and the impact of ChatGPT on nursing practice. The primary objectives included categorising the papers, identifying the most influential authors, delineating the prominent areas and institutions in the field, and examining the impact of ChatGPT on nursing education and practice. The findings indicate that ChatGPT positively impacts nursing education by enhancing learning experiences, improving communication, and aiding clinical decision-making. The findings indicate that journal articles accounted for 76% of publications, with the U.S. leading in research output. The findings indicate that ChatGPT positively impacts nursing education by enhancing learning experiences, improving communication, and aiding clinical decision-making. Future research should focus on establishing frameworks for integrating ChatGPT into nursing education, addressing ethical implications, and assessing the long-term impacts on patient care.
Introduction: Metabolic disturbances caused by high-calorie diets contribute significantly to global mortality. Trans-3-hydroxycinnamic acid (HCA), a bioactive antioxidant, may offer protective effects against such imbalances. This study evaluated the metabolic, biochemical, and haematological effects of HCA in rats fed a high-fat, high-fructose (HFHF) diet. Materials and Methods: Male Sprague Dawley rats aged 7-8 weeks were fed with HFHF diet for 6 consecutive weeks. Rats with metabolic disturbances received HCA at 15 mg/kg, 30 mg/kg, or 60 mg/kg, and were continuously fed with HFHF diet for another 6 weeks. Normal control rats received normal pellets. The effects of HCA on metabolic indices, biochemical, and haematological parameters were evaluated. Results: HCA treatment for 6 weeks ameliorates metabolic indices, including weight gain, Lee obesity index, abdominal and thoracic circumferences, TC/HDL ratio, glucose, and fat pad deposition. Improved AST and ALT levels indicated the hepatoprotective effect of HCA, supported by decreased fat vacuolation. The most significant effects were observed at 30 mg/kg. No significant haematological or renal toxicity was detected. Conclusion: Our results indicated HCA at 30 mg/kg is the optimum dose that exerts its ameliorative effects in reducing metabolic indices, along with no severe biochemical and haematological changes.
Neurofibromatosis type 1 (NF1) is a genetic disorder characterized by an increased risk of various tumours, including breast cancer, particularly in women under 50. This case report discusses a 47-year-old woman with NF1 who was diagnosed with metastatic invasive ductal carcinoma of the breast. She initially presented with respiratory symptoms, and subsequent clinical evaluation revealed a left breast ulcer and underlying mass, which the patient had attributed to NF1-related cutaneous changes. Histopathological examination confirmed bilateral hormone receptor positive, HER2-negative invasive breast carcinoma with metastatic involvement. Management options, including systemic therapy, were discussed within a multidisciplinary team, and the patient elected to proceed with endocrine therapy using Tamoxifen. This case highlights the clinical complexity of breast cancer detection in individuals with NF1, where overlapping benign cutaneous manifestations may influence symptoms interpretation. It also highlights the importance if early and regular breast cancer screening, beginning at age 30, using appropriate imaging modalities such as mammography and contrast-enhanced breast MRI. Individualised screening strategies patient education remain essential to optimise outcomes in this high-risk population.
INTRODUCTION: Iron overload is a major concern in transfusion-dependent thalassaemia patients, with soluble transferrin receptors (sTfR) playing a key role in iron regulation. This study aimed to evaluate the gene expression of TfR1 and TfR2 and their association with ineffective erythropoiesis (IE) and iron overload in HbE/β-thalassaemia patients. MATERIALS AND METHODS: A total of 2 ml whole peripheral blood was extracted for RNA from 6 subjects recruited from each HbE/β-thalassaemia patient, β-thalassaemia trait carriers, and healthy controls. TfR levels were measured using ELISA, while TfR1 and TfR2 gene expression were assessed using RT-qPCR. Data were analysed using ANOVA, Student’s t-test, Kruskal–Wallis, and Mann–Whitney U tests with Bonferroni correction. RESULTS: Gene expression analysis revealed a significant downregulation of TfR2 in HbE/β-thalassaemia patients and β-thalassaemia carriers (P<0.001) compared to healthy controls, while TfR1 expression was significantly upregulated (P<0.001). Additionally, sTfR levels were statistically higher in HbE/β-thalassaemia patients and parents compared to healthy controls (P<0.001). CONCLUSION: These findings suggest that TfR1 and TfR2 expression patterns may serve as potential biomarkers for assessing IE and iron overload in β-thalassaemia. Furthermore, elevated sTfR levels indicated that the transfusion regimen was insufficient to suppress ineffective erythropoiesis. In β-thalassaemia intermedia patients, haemoglobin levels may not be the most reliable marker for monitoring transfusion therapy, whereas sTfR could help in tailoring individualised transfusion regimens.
Chronic myeloid leuka;emia (CML) demonstrates variable responses to tyrosine kinase inhibitors (TKI). The prognostic impact of bone marrow fibrosis (BMF), particularly at diagnosis, remains under-recognised, especially in adolescent patients. We report a case of a 14-year-old male diagnosed with chronic-phase CML who progressed rapidly to blast crisis within 12 months. Despite treatment with imatinib followed by nilotinib, the patient failed to achieve a complete cytogenetic response due to severe cytopenia and frequent dose interruptions. Retrospective analysis of the initial bone marrow biopsy revealed grade 3 fibrosis. The disease remained refractory despite high-dose induction chemotherapy. This case highlights the potential prognostic relevance of BMF in adolescent CML and supports the integration of reticulin staining into the diagnostic workup to guide timely intervention.
INTRODUCTION: Amid growing concerns about mental health in academic settings, especially among international students facing cross-cultural stress and stigma, understanding factors associated with mental health help-seeking attitudes is crucial for effective strategies. This study aimed to examine mental health help-seeking attitudes and associated factors among Chinese international university students in Malaysia. MATERIALS AND METHODS: A cross-sectional study was conducted from October 2024 to July 2025 among Chinese international students selected through convenience sampling. Data were collected using a questionnaire comprising sociodemographic characteristics, the Attitude Toward Seeking Professional Psychological Help-Short Form (ATSPPH-SF), the Language Proficiency subscale of the Revised Sociocultural Adaptation Scale (SCAS-R), the SelfStigma of Seeking Help Scale (SSOSH-3), the Stigma Scale for Receiving Psychological Help (SSRPH), and the Multidimensional Scale of Perceived Social Support (MSPSS). Data were analysed using descriptive statistics and multiple linear regression. RESULTS: A total of 222 participants were analysed. The median help-seeking attitude score was 16.5 (IQR: 14-21). Self-stigma (adjusted beta=-0.550, p<0.001) and students from health and life sciences field (vs. science and technology) (adjusted beta=-2.533, p=0.027) were significant negative predictors, age (adjusted beta=0.148, p=0.030) and social support (adjusted beta=0.072, p=0.011) were significant positive predictors. CONCLUSION: Personal and environmental factors were associated with mental health help-seeking attitudes. Universities may improve attitudes by strengthening support systems. Future studies are recommended to further explore strategies to improve mental health help-seeking attitudes among international university students.
Introduction: Pre-operative anxiety is associated with physiological and psychological implications in the peri-operative period. Pre-operative education and anaesthesia information provision help alleviate concerns and anxiety regarding anaesthesia for planned surgeries. This study aims to compare differences in levels of anxiety with anaesthesia information provision and factors contributing to anxiety. Materials and Methods: Seventy patients, aged between 18 and 65, with American Society of Anesthesiologists classes I or II undergoing planned surgery were recruited into this study. They were divided into Group A, which received regular pre-anaesthetic counselling one day prior to surgery, and Group B, which received the counselling and an anaesthesia information sheet (AIS). Both groups were then given an Amsterdam Preoperative Anxiety Information Scale (APAIS) questionnaire at the end of the pre-anaesthetic visit and again on the morning of the planned surgery. The scores were calculated to determine the level of anxiety. Results: Group B showed a significant reduction in anxiety levels compared to Group A [Difference (95% CI): -1.51 (-1.96, -1.07); p< 0.001]. For the information desire component, a significant decrease was observed in both Group A (p = 0.037) and Group B (p< 0.001). Group B demonstrated a greater decrease [Difference (95% CI): - 1.17 (-1.62, -0.73)] compared to Group A [Difference (95%CI): -0.40 (-0.77, -0.03)]. Past surgical history was a factor shown to be of statistical significance [coeff (95% CI): -2.39 (-4.21, -0.57); p= 0.011]. Conclusion: Provision of AIS significantly reduced the level of anxiety in patients undergoing planned surgery and has been shown to alleviate concerns in patients with no past surgical history.
INTRODUCTION: Hypertension in young adults is associated with a prolonged disease course and elevated lifetime cardiovascular risk, significantly affecting quality of life (QoL). Despite its growing prevalence and potential to affect multiple QoL dimensions, this relationship remains understudied in Malaysia. This study aimed to compare QoL between normotensive (NT) and hypertensive (HTN) young adults. MATERIALS AND METHODS: A cross-sectional study involving 124 participants (64 NT and 60 HTN) aged 18-39 years. QoL was assessed using the validated WHOQOL-BREF questionnaire across four domains: physical health, psychological well-being, social relationships, and environmental satisfaction. Body mass index, waist-to-hip ratio, and sociodemographic data were also collected. RESULTS: The HTN group demonstrated significantly lower scores than the NT group in physical health (67.5 +/- 14.5 vs 73.67 +/- 15.5, p=0.024) and in environmental domains (71.0 +/- 12.4 vs 75.5 +/- 11.3, p=0.037). Waist-to-hip ratio was the only consistent factor across all QoL domains, showing significant negative associations with physical health (B=-33.920, p=0.025), psychological well-being (B=-27.444, p=0.049), social relationships (B=-35.662, p=0.048), and the environmental domain (B=-38.132, p = 0.001). Body mass index was negatively associated with physical health (B=-0.495, p=0.045), and employment status was significantly associated with psychological well-being (B=-7.931, p=0.022). CONCLUSION: Hypertension management in young adults should extend beyond blood pressure control to encompass broader QoL considerations, particularly addressing central obesity and psychosocial determinants of health.
Introduction: Handgrip and pinch strength are critical indicators of upper limb function and health, and may be affected by cardiometabolic conditions such as type 2 diabetes mellitus (T2DM), hypertension (HPT), and hyperlipidemia (HPL). This study aimed to compare handgrip and pinch strength among healthy adults, individuals with T2DM+HPT, and those with T2DM+HPT+HPL in a Malaysian population. Materials and Methods: A cross-sectional study was conducted with 204 adults (n=68 per group), matched by age, gender, and health condition. Handgrip and pinch strength were assessed using the Jamar Hydraulic Dynamometer and Pinch Gauge following the American Society of Hand Therapists (ASHT) protocol. Statistical analyses included One-way ANOVA and Pearson correlation. Results: Hand strength differed significantly across groups (p<0.001). Healthy adults demonstrated higher grip and pinch strength than participants with T2DM+HPT and T2DM+HPT+HPL. Strength measures showed strong bilateral correlations (0.85-0.92, p<0.001). Weak positive associations were observed between random blood sugar and grip/pinch strength (r=0.239-0.271), while diastolic blood pressure showed weak associations with grip strength only (r=0.239-0.265). HbA1c was not significantly associated with hand strength. Conclusion: Cardiometabolic conditions are associated with reduced hand strength, particularly when T2DM coexists with HPT and HPL. Grip and pinch strength may serve as accessible functional markers for clinical assessment and early intervention in at-risk populations.
INTRODUCTION: Myopia is a global public health issue. Advanced myopia can lead to potentially serious ocular pathologies such as glaucoma and maculopathy, thus controlling progression of myopia is essential. Orthokeratology (Ortho-K) has been shown to be effective in controlling the progression of myopia in children. However, limited data is available on this from the East Asian populations. This study investigated the efficacy of Ortho-K in controlling the progression of myopia in children in Kuala Lumpur. The results were compared with those for single vision spectacles (SVS). MATERIALS AND METHODS: Children aged 8-9 years, with myopia of -0.50 to -4.00D and astigmatism of ≤1.00D, were invited to participate. Cycloplegic refraction at the central and peripheral retina, visual acuity (VA), corneal topography, and axial length (AL) measurements were taken at baseline (BL) and every 6 months over a 1-year period. RESULTS: In all, 70 children (35 males and 35 females), with a mean age of 8.31±0.47 years, participated. Forty-five children were fitted with Ortho-K lenses and 25 with SVS. Significant changes in the refraction, corneal curvature, and AL were found over the study period and between the groups (p<0.05). Significant myopic shifts in the relative peripheral refraction (RPR) (p<0.01) were noted in the Ortho-K wearers, while hyperopic shifts (p<0.01) were found in the SVS group. Myopia progression and AL elongation were slowed by around 50% and 44%, respectively. CONCLUSION: Wearing the Ortho-K lenses for 12M is effective in controlling myopia progression children and can be recommended when managing myopic children.
