Background:Hearing loss affects approximately 432 million adults globally, with Deaf individuals representing a distinct linguistic and cultural minority that faces significant barriers to accessing health information. These challenges contribute to health disparities by limiting preventive education and timely health interventions. Objective:This scoping review examines the effectiveness of digital communication technologies in promoting health literacy, awareness, and health-related skills among Deaf adults and children. Methods:A comprehensive literature search was conducted across 5 major databases: MEDLINE, Embase, Scopus, Web of Science, and PubMed, focusing on peer-reviewed studies published in English within the past 10 years. Seventeen studies were included, encompassing a variety of research designs, including randomized controlled trials, cross-sectional surveys, and mixed methods approaches. Data extraction focused on intervention type, outcomes, and target populations. Results:Findings indicate that video-based interventions are the most prevalent and effective, leveraging sign language, subtitles, and animations to enhance accessibility and comprehension. These digital tools improved health awareness, knowledge acquisition, and the practical application of health-related skills across both adult and child populations. Interventions ranged from stroke preparedness and cancer education to breast self-examination and cardiopulmonary resuscitation training. Social media platforms, SMS text messaging campaigns, and eHealth programs were also identified as effective in promoting preventive health behaviors. Despite these promising outcomes, several challenges remain, including limited digital literacy, inconsistent access to technology, and a lack of culturally and linguistically appropriate content. Additionally, most studies were geographically concentrated in the United States, with a limited number of high-quality randomized trials. Conclusions:This review highlights the transformative potential of accessible digital technologies to reduce health disparities and promote health equity among Deaf individuals. Future research should prioritize inclusive, culturally sensitive, and user-centered designs and explore emerging platforms to maximize engagement and improve health outcomes.

Objectives:This study investigates the feasibility of the Deaf in Touch Everywhere (DITE™) app, which was developed to provide virtual interpretation services through teleconferencing; and factors influencing adaptation and utilization by stakeholders in simulated healthcare consultations. Methods:Focus group discussions (FGDs) were conducted involving three stakeholder groups: Malaysian sign language (BIM) users (BNUs), BIM interpreters (JBIMs) and healthcare providers (HCPs). They were involved in simulated medical consultations via video conferencing using the DITE™ app. Interview questionnaires were designed using the extended Unified Theory of Acceptance and Use of Technology (UTAUT). Results were thematically analysed. Results:Nineteen participants (six BNUs, six JBIMs, seven HCPs) participated in three FGDs. Findings were categorized according to the five UTAUT categories and were explored within each participant group: Performance expectancy - strengths and limitations of the DITE™ app; Effort expectancy - adaptation, challenges and navigation of the app; Social influence - concerns about data privacy/confidentiality, medicolegal acceptance and encouragement to use app from relevant stakeholders; Facilitating conditions - confidentiality, support availability, prior relationship with interpreters, previous consultation experiences and familiarity with telecommunication tools; Behavioural intention - app usage and promotion and comparing telemedicine and face-to-face consultations with the DITE™ app. Limiting conditions and areas for improvement were also discussed. Conclusion:The DITE™ app holds the potential to tackle communication barriers between Deaf individuals and HCPs. However, ongoing research, improvements in functionality and strategic deployment are vital to maximize its effectiveness in enhancing healthcare accessibility and outcomes for the Deaf community in Malaysia.

Abstract Breast cancer is the leading cause of cancer-related mortality among women worldwide. Triple-negative breast cancer (TNBC), representing ∼15% of cases, disproportionately contributes to this burden due to its aggressive growth, absence of targeted therapies, and high rates of chemoresistance. Tocotrienol-rich fraction (TRF), a vitamin E mixture with documented cytotoxic effects in preclinical models, represents a promising therapeutic candidate for TNBC. However, its mechanisms of action—especially the involvement of long non-coding RNAs (lncRNAs), key mediators of tumour progression and drug response—remain poorly understood. This study investigated the role of lncRNAs in mediating the cytotoxic effects of TRF in TNBC. MDA-MB-468 cells were treated with TRF (17 µg/ml, 72 hours), and transcriptomic profiling was performed using the Clariom™D microarray. Differentially expressed genes were identified (|fold change| > 2, p < 0.05) and then used to construct a lncRNA-mRNA co-expression network (Pearson’s correlation, |r| > 0.99, p < 0.05). Pathway enrichment analysis of the co-expressed mRNAs was carried out using the clusterProfiler package and the Reactome database. The network was visualised with Cytoscape and the hub genes were identified via cytoHubba with the Maximal Clique Centrality algorithm. TRF treatment altered the expression of 2,481 genes, including 306 lncRNAs (200 upregulated, 106 downregulated). The top enriched pathways identified by the functional enrichment of co-expressed mRNAs were related to the cell cycle and endoplasmic reticulum stress (ERS) pathways. Notably, DLGAP1-AS2 was identified as a highly upregulated hub gene and was correlated with the increased expression of PERK and CHOP, two key effectors of the unfolded protein response, an ERS pathway, which is capable of triggering apoptosis. These findings identify lncRNAs as important mediators of TRF-induced cytotoxicity in TNBC, and implicate DLGAP1-AS2 as a potential regulator of ERS–mediated apoptosis via the PERK/CHOP axis. Citation Format: Jacelyn Lee Sweet Yee, Uma Devi Palanisamy, Kasthuri bai Magalingam, Reyhaneh Farghadani, Ammu Kutty Radhakrishnan. Modulation Of Long Non-Coding RNAs In Triple-Negative Breast Cancer Cells By Tocotrienol-rich Fraction from Palm Oil [abstract]. In: Proceedings of Frontiers in Cancer Science 2025; 2025 Nov 5-7; Singapore. Philadelphia (PA): AACR; Cancer Res 2026;86(13_Suppl):Abstract nr P115.

Most studies on vitamin E and immunity have focused on tocopherols, but the tocotrienol-rich fraction (TRF) from palm oil may exert stronger immunomodulatory effects. This study investigated the effect of various TRF doses on the immune response to influenza immunisation in healthy adults. We hypothesized daily supplementation with lower doses of TRF can boost immune response to the influenza vaccine in healthy Individuals. In a double-blind placebo-controlled trial, 150 participants (≥18 years) were randomised to receive placebo or TRF (50, 100, 200, or 400 mg) daily for 2 months, with vaccination on day 28. Blood samples collected on days 0, 28, and 56 were analyzed for humoral and cellular immunity, antioxidant status, and plasma concentrations of vitamin E. TRF significantly augmented anti-influenza antibody production across all doses, with the 400 mg group exhibiting the highest titers. A selective Th1-type immune response was observed, characterized by significant IFN-γ production upon restimulation in all TRF-supplemented groups compared with placebo. Plasma IL-12 was elevated in the highest dose, whereas the amount of EBI3 produced increased across a broader range of doses compared to placebo. TRF supplementation was associated with increased antioxidant enzyme activities and stable malondialdehyde activity. Elevated α-tocopherol concentrations observed, primarily at higher doses. Supplementation with TRF can enhance immune response to influenza immunisation by modulating humoral, Th1 responses and improving antioxidant status. Critically, antibody production increased similarly across all TRF doses, suggesting that lower doses may offer a cost-effective strategy for supporting humoral immunity, while higher doses provide broader immunomodulatory benefits.

Abstract Ellagitannins and ellagic acid are microbially converted into urolithins, metabolites associated with antioxidant, anti-inflammatory, and mitochondrial-related activities. Although several human-derived urolithin-producing strains and their associated enzymes have recently been characterised, the diversity of microbial strategies across host systems remains poorly understood. This study investigated urolithin production in the Sprague-Dawley rat faecal-derived microbial communities supplemented with rambutan rind extract, an ellagitannin-rich agricultural by-product containing 35–40% geraniin. Rambutan rind extract supplementation was associated with reduced isobutyric acid levels at study endpoint. Ex vivo anaerobic fermentation of hydrolysed rambutan rind extract (113 µM ellagic acid equivalent) resulted in the formation of urolithin C (9.4 ± 0.6 µM) and Isourolithin A (12.5 ± 0.6 µM) by day 9. Shotgun metagenomics analysis revealed very low relative abundance of Actinobacteria (< 0.009%), despite this phylum encompassing most previously characterised urolithin-producing taxa. Canonical ellagic acid degradation genes and the MetaCyc EA degradation pathway were not detected. Comparative pathway analysis indicated overlap in general metabolic pathways with Ellagibacter isourolithinifaciens DSM 104140T reflecting shared metabolic frameworks rather than conserved urolithin biosynthetic pathways, with highly divergent homologues (Eadh1, Eadh2, Eadh3, and Ucdh). Together, these findings demonstrate that rambutan rind extract can support urolithin formation in rat faecal-derived microbial consortia and highlight functional associations consistent with alternative or yet-uncharacterised microbial strategies for ellagitannin biotransformation. These findings support a discovery-driven framework for investigating urolithin biotransformation in non-human gut microbiomes using ellagitannin-rich agricultural substrates. Key points • Rambutan rind extract supports urolithin formation in rat-derived gut microbiota. • Substrate concentration influences urolithin production under ex vivo conditions. • Rat gut microbiota shows homologues’ divergence in urolithin-associated proteins.

Background: The increasing global interest in consuming plant-based diets, especially the vegan diet, is fuelled by ethical, health, and environmental concerns. A balanced and diverse vegan diet has the potential to play a significant role in achieving and sustaining optimal health, particularly in diet-based interventions for metabolic syndrome. Scope and approach: This systematic review evaluated randomised controlled trials, to elucidate the effects of a strict vegan diet on individual components of metabolic syndrome in the human population. A comprehensive literature search was conducted across four databases (Cochrane Central Register of Controlled Trials; Embase via Ovid; Ovid Medline; Scopus). The search covered articles published between 2013 and 2024, specifically targeting MeSH terms associated with "vegan" and "metabolic syndrome.". Data extraction and quality assessment were independently carried out by two reviewers. Key findings and conclusion: Out of the 4094 identified publications, 18 articles were included, detailing 11 distinct trials. Subgroup analysis revealed that vegan diets significantly reduced body weight (-10.37 kg; 95 % CI: [7.07, 13.67]; p < 0.00001), BMI (-2.68 kg/m(2); 95 % CI: [1.87, 3.85]; p < 0.00001), LDL-c (-0.44; 95 % CI: [0.40, 0.48]; p = 0.0001), total cholesterol (-0.42 mmol/L; 95 %CI: [-0.73, -0.12]; p = 0.007), and HbA1c (-0.17 %; 95 % CI: [0.01, 0.32]; p = 0.04) with the most pronounced effects seen in individuals with metabolic syndrome and type 2 diabetes mellitus. These improvements are likely mediated by enhanced satiety, reduced saturated fat intake, improved insulin sensitivity, and gut microbiota modulation. However, no consistent effects were observed in triglycerides, HDL-c, or blood pressure, and substantial heterogeneity was noted across some outcomes. Overall, vegan diets demonstrate promising potential as a sustainable, non-pharmacological strategy for managing cardiometabolic risk, particularly in individuals with existing metabolic dysfunction.

Urolithins are microbial metabolites derived from ellagitannins that have attracted increasing interest for their potential health benefits. Among them, urolithin A is particularly recognised for its role in inducing mitophagy. However, urolithin production is influenced by the differences in gut microbiota composition and metabotypes resulting from interindividual variability. To decipher microbial pathways responsible for urolithin biosynthesis, an accurate and cost-effective screening method is essential for studying their biotransformation in biological and fermentation systems. This study presents the development and validation of a high-performance liquid chromatography method as an accessible alternative to mass-spectrometry, offering an efficient, low-cost, and high-throughput screening of urolithins in anaerobic basal broth. Validation was performed according to ICH guidelines, assessing linearity, sensitivity, precision, accuracy, specificity, and matrix effects. The optimised method demonstrated excellent linearity (all r = 1) across the range of 3.125-100 mu g/ml, with low detection and quantification limits, making it suitable for trace-level analysis. Precision and recovery rates were high (%RSD <5; recovery >= 98 %), and matrix effects were negligible (all p > 0.05), confirming its reliability and reproducibility. Its minimal solvent usage, excellent green profile, and reduced operational costs make it an environmentally sustainable and efficient tool for high throughput urolithin screening in fermentation and microbiome studies.

Breast cancer (BC) is the most prevalent cancer among women. Despite improvements in the detection and treatment of BC, drug resistance is widespread, making it the leading cause of cancer mortality in women. Long non-coding RNAs (lncRNAs) have been shown to play essential roles in regulating drug resistance in pre-clinical models. However, their clinical relevance remains largely unexplored. This review addresses this gap by identifying and examining lncRNAs with potential predictive value as biomarkers for drug resistance in BC cancer patients. A systematic search (last updated February 7, 2024) was conducted across five databases (Cochrane Library, Embase, PubMed, Scopus, and Web of Science) for research articles in English, published after 2010, involving BC patients who underwent treatment. Following the selection and review process, 66 studies were short-listed, and 185 unique lncRNAs linked to drug resistance in BC patients were identified. Notably, only five lncRNAs (BCAR4, CCAT2, DSCAM-AS1, GAS5, and H19) were reported in at least two independent studies, indicating the scarcity of replicated evidence in clinical cohorts. Receiver operating characteristic curve analysis for these five lncRNAs confirmed that BCAR4, GAS5, and H19 expression levels have prognostic potential for predicting chemotherapy response. However, further validation is required before lncRNAs can be effectively utilized as prognostic markers in a clinical setting.

Carotenoids, known for their immunomodulatory and gut microbiota-modulating effects, have drawn attention as potential dietary adjuvants to enhance vaccine efficacy and maintain gut health. This study aimed to evaluate the effect of carotene supplementation on immune response with insight into gut microbiome using an in vivo animal model. The BALB/c mice were fed daily with CaroGaia (50 mg/kg of body weight), a carotene supplement that contained 33.3% α-carotene and 66.6% β-carotene, by oral gavage for 70 days. Mice fed with the vehicle served as controls. The mice in the vaccinated groups received two doses of the CoronaVac inactivated virus vaccine on days 14 and 42. Flow cytometry revealed no significant modulation of lymphocyte subsets (total T lymphocytes, T-helper cells, cytotoxic T lymphocytes, and B cells) with carotene supplementation. In addition, there were no significant differences in the levels of SARS-CoV-2 immunoglobulin G and interferon-gamma in plasma between treatment and control groups. In contrast, the vaccinated carotene group showed an increased SARS-CoV-2 antigen-specific splenocyte proliferation. In the gut microbiome, carotene supplementation appeared to alter the gut microbiota composition. However, no significant changes were observed in the short-chain fatty acids (SCFA) levels, such as acetic acid, butyric acid, and propionic acid. Furthermore, the differential abundance analysis showed that carotene supplementation reduced the levels of SCFA producers (Odoribacter and Monoglobus genera) in unvaccinated mice compared to the control group, while it enriched the level of SCFA producers (Ruminococcaceae family) and reduced pathobiont levels, commensal bacteria that have pathogenic potential (Mucispirillum genus), in the vaccinated group.

Aim: This study aimed to elucidate the structural basis for the interaction of five natural anti-arthritic compounds, diacerein, rhein, glucosamines [glucosamine 3-sulfate (G3S), and glucosamine 6-sulfate (G6S)], and chondroitin disaccharide Δdi-4S (C4S) with cytochrome P450 2C9 (CYP2C9). Methods: The investigated compounds were docked individually to the defined binding site in CYP2C9 based on the published crystal structure (PDB code: 1R9O). Results: All investigated ligands bound deep in the active site pocket in close proximity to the heme. Except for chondroitin, all ligands are bonded to residues found in critical secondary structures that form the boundary of the active site cavity, including B-C loop, F helix, F-G loop, and I helix. A total of 12 amino acids were involved in the binding, and all were critical residues located in four out of six substrate recognition sites (SRSs) that have been identified as important substrate binding and catalysis regions in other CYP isoforms. The relatively more potent binding (lower CDOCKER interaction energy) observed for diacerein and rhein compared to glucosamines and C4S are likely due to two main factors: a higher number of bonds between the ligand molecule and CYP2C9 active site residues (14 versus 0–4), and direct interaction with the heme moiety. The binding residues identified in both diacerein and rhein were the residues that also bonded with sulfaphenazole, the specific and potent CYP2C9 inhibitor. Conclusions: Collectively, this study has provided insights into structural features of CYP2C9 critical for inhibition and formed a basis for further exploration of structural determinants for potency and specificity of therapeutic compounds as CYP2C9 inhibitors.

Background Vitamin E from palm oil, known as the tocotrienol-rich fraction (TRF), has been shown to have immune-enhancing activity. To date, only one dose of TRF (400 mg daily) has been tested in a clinical trial. The proposed study will evaluate the immune-enhancing activity effects of lower doses (200, 100 and 50 mg) in a clinical trial using an influenza vaccine as the immunological challenge. Methods A single-centre, randomised, parallel, double-blinded, placebo-controlled clinical trial with balance allocation involving five arms will be conducted. The healthy volunteers recruited will be randomly assigned to one of the arms, and they will be asked to take the respective supplements (400 mg, 200 mg, 100 mg, 50 mg of TRF or placebo) daily with their dinner. The volunteers will receive the influenza vaccine after four weeks. They will be asked to return to the study site four weeks later. A blood sample will be taken for the study at baseline, four and eight weeks. Primary outcome measures will be antibody levels to influenza, blood leucocyte profile and cytokine production. Secondary outcomes will be correlating plasma vitamin E levels with immune responses, plasma proteins and gene expression patterns. The findings from this study will be published in relevant peer-reviewed journals and presented at relevant national and international scientific meetings. Conclusions The recent world events have created the awareness of having a healthy and functional immune system. Nutrition plays an important role in helping the immune system to function optimally. This study will show the effects of lower doses of TRF in boosting the immune response of healthy individuals and also elucidate the mechanisms through which TRF exerts its immune-enhancing effects. Clinical trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) [ACTRN12622000844741] dated 15 June 2022. Protocol version 2

Recently, dermatology has increasingly focused on understanding skin aging and exploring novel therapeutic approaches. Despite progress in cosmetic and pharmaceutical research, a significant gap remains in comprehensively understanding the effects and mechanisms of herbal extracts on skin aging. While many studies have examined the bioactivities of herbal compounds in preclinical models, comprehensive human trials have been scarce over the past decade. This review aims to address this gap by synthesizing human trials from the past decade, focusing on the therapeutic effects of herbal extracts on skin aging. The objective is to unravel the mechanisms contributing to skin aging and assess the therapeutic potential of herbal compounds. Following the PRISMA 2020 guideline, a systematic review was performed across OvidMEDLINE, Cochrane Central Register of Controlled Trials, and Embase via Ovid. A meticulous search strategy identified relevant clinical trials. The review highlights the essential role of herbal compounds in skin aging, particularly their antioxidant activity in suppressing the aging process. Analysis of 51 clinical trials offers valuable insights into their diverse effects on skin aging parameters. Herbal compounds are promising alternatives to synthetic products for treating skin aging. Their demonstrated efficacy in mitigating wrinkles, enhancing elasticity, maintaining hydration, and controlling pigmentation underscores their potential in developing antiaging therapeutics. However, further studies are needed to identify specific compounds responsible for these effects and understand their mechanisms. Future directions include conducting large-scale trials, exploring synergies with other ingredients, and optimizing delivery systems for sustainable, effective antiaging therapies.

Background Deaf individuals confront healthcare disparities from communication barriers, aggravated by Deaf culture ignorance and limitations of lip-reading. While medically-trained sign language interpreters (SLIs) offer solutions, shortages persist. Thus, the Deaf in Touch Everywhere (DITE™) app was developed to provide virtual SLI services through teleconferencing. This study investigates the app's feasibility and factors influencing the adaptation and utilization by the stakeholders.Methods This study adheres to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines. Participants (≥ 18 years) were purposively sampled and comprised of three stakeholder groups: Malaysian sign language (BIM) users (BNUs), BIM interpreters (JBIMs), and healthcare providers (HCPs). They were involved in simulated medical consultations via video conferencing using the DITE™ app. Following this, three focus group discussions (FGDs) were conducted. Interview questionnaires were designed using the extended Unified Theory of Acceptance and Use of Technology (UTAUT); encompassing performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioural intention. Recorded interviews with JBIMs and HCPs were transcribed verbatim, while transcripts from BNUs were derived from video recordings. Results were imported into NVivo 12 software, and thematic analysis was performed.Results Nineteen participants, comprising six BNUs, six JBIMs, and seven HCPs, participated in three FGDs. The findings were categorized according to the five UTAUT categories and were explored within each participant group. Within the performance expectancy, themes relating to the strengths and limitations of DITE app emerged. Effort expectancy themes encompassed adaptation/adjustment, challenges/setbacks, and navigation/interface of the app. Social influence themes included concerns about data privacy/confidentiality, medicolegal acceptance, and encouragement to use app from relevant stakeholders. Facilitating conditions encompassed themes like confidentiality, support availability, prior relationship with interpreters, previous consultation experiences, and familiarity with telecommunication tools. Regarding behavioural intention, themes that emerged were app usage and promotion and comparing telemedicine and face-to-face consultations with DITE app. In addition, limiting conditions and areas for improvement were discussed.Conclusion The DITE app holds the potential to tackle communication barriers between Deaf individuals and HCPs. However, ongoing research, fine-tuning, and strategic deployment are vital to maximize its effectiveness in enhancing healthcare accessibility and outcomes for the Deaf community in Malaysia.

Background Ineffective communication with Deaf individuals in healthcare settings has led to poor outcomes including miscommunication, waste, and errors. To help address these challenges, we developed a mobile app, Deaf in Touch Everywhere (DITE TM ) which aims to connect the Deaf community in Malaysia with a pool of off-site interpreters through secure video conferencing. Objectives The aims of this study were to (a) assess the feasibility and acceptability of measuring unified theory of acceptance and use of technology (UTAUT) constructs for DITE TM with the Deaf community and Malaysian sign language (BIM) interpreters and (b) seek input from Deaf people and BIM interpreters on DITE TM to improve its design. Methods Two versions of the UTAUT questionnaire were adapted for BIM interpreters and the Deaf community. Participants were recruited from both groups and asked to test the DITE app features over a 2-week period. They then completed the questionnaire and participated in focus group discussions to share their feedback on the app. Results A total of 18 participants completed the questionnaire and participated in the focus group discussions. Ratings of performance expectancy, effort expectancy, facilitating conditions and behavioural intention were high across both groups, and suggestions were provided to improve the app. High levels of engagement suggest that measurement of UTAUT constructs with these groups (through a modified questionnaire) is feasible and acceptable. Conclusions The process of engaging end users in the design process provided valuable insights and will help to ensure that the DITE TM app continues to address the needs of both the Deaf community and BIM interpreters in Malaysia.

Geraniin (GE), an ellagitannin (ET) renowned for its promising health advantages, faces challenges in its practical applications due to its limited bioavailability. This innovative and novel formulation of GE and soy-phosphatidylcholine (GE-PL) complex has the potential to increase oral bioavailability, exhibiting high entrapment efficiency of 100.2 ± 0.8 %, and complexation efficiency of 94.6 ± 1.1 %. The small particle size (1.04 ± 0.11 μm), low polydispersity index (0.26 ± 0.02), and adequate zeta potential (-26.1 ± 0.12 mV), indicate its uniformity and stability. Moreover, the formulation also demonstrates improved lipophilicity, reduced aqueous and buffer solubilities, and better partition coefficient. It has been validated by various analytical techniques, including Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), and X-ray diffraction (XRD) studies. Oral bioavailability and pharmacokinetics of free GE and GE-PL complex investigated in rabbits demonstrated enhanced plasma concentration of ellagic acid (EA) compared to free GE. Significantly, GE, whether in its free form or as part of the GE-PL complex, was not found in the circulatory system. However, EA levels were observed at 0.5 h after administration, displaying two distinct peaks at 2 ± 0.03 h (T1max) and 24 ± 0.06 h (T2max). These peaks corresponded to peak plasma concentrations (C1max and C2max) of 588.82 ng/mL and 711.13 ng/mL respectively, signifying substantial 11-fold and 5-fold enhancements when compared to free GE. Additionally, it showed an increased area under the curve (AUC), the elimination half-life (t1/2, el) and the elimination rate constant (Kel). The formulation of the GE-PL complex prolonged the presence of EA in the bloodstream and improved its absorption, ultimately leading to a higher oral bioavailability. In summary, the study highlights the significance of the GE-PL complex in overcoming the bioavailability limitations of GE, paving the way for enhanced therapeutic outcomes and potential applications in drug delivery and healthcare.

Background Ineffective communication with Deaf individuals in healthcare settings has led to poor outcomes including miscommunication, waste, and errors. To help address these challenges, we developed a mobile app, Deaf in Touch Everywhere (DITE TM ) which aims to connect the Deaf community in Malaysia with a pool of off-site interpreters through secure video conferencing. Objectives The aims of this study were to (a) assess the feasibility and acceptability of measuring unified theory of acceptance and use of technology (UTAUT) constructs for DITE TM with the Deaf community and Malaysian sign language (BIM) interpreters and (b) seek input from Deaf people and BIM interpreters on DITE TM to improve its design. Methods Two versions of the UTAUT questionnaire were adapted for BIM interpreters and the Deaf community. Participants were recruited from both groups and asked to test the DITE app features over a 2-week period. They then completed the questionnaire and participated in focus group discussions to share their feedback on the app. Results A total of 18 participants completed the questionnaire and participated in the focus group discussions. Ratings of performance expectancy, effort expectancy, facilitating conditions and behavioural intention were high across both groups, and suggestions were provided to improve the app. High levels of engagement suggest that measurement of UTAUT constructs with these groups (through a modified questionnaire) is feasible and acceptable. Conclusions The process of engaging end users in the design process provided valuable insights and will help to ensure that the DITE TM app continues to address the needs of both the Deaf community and BIM interpreters in Malaysia. Keywords UTAUT , Deaf , participatory design , mHealth , sign-language interpreters

The study addressed a significant gap in the profiling and understanding of the gut microbiota’s influence on Malaysian Malay women with gestational diabetes mellitus (GDM). This prospective cohort study aimed to explore the intricate relationship between gut microbiota, dietary choices, and lifestyle factors among Malay women, both with and without GDM. The research specifically focused on participants during the second (T0) and third (T1) trimesters of pregnancy in Johor Bahru, Malaysia. In Part 1 of the study, a diverse pool of pregnant women at T0 was categorized into two groups: those diagnosed with GDM and those without GDM, with a total sample size of 105 individuals. The assessments encompassed demographic, clinical, lifestyle, and dietary factors at the T0 and T1 trimesters. Part 2 of the study delved into microbiome analysis, targeting a better understanding of the gut microbiota among the participants. Stool samples were randomly collected from 50% of the individuals in each group (GDM and non-GDM) at T0 and T1. The collected samples underwent processing, and 16s rRNA metagenomic analysis was employed to study the microbial composition. The results suggested an association between elevated body weight and glucose levels, poor sleep quality, lack of physical activity, greater intake of iron and meat, and reduced fruit consumption among women with GDM compared to non-GDM groups. The microbiome analysis revealed changes in microbial composition over time, with reduced diversity observed in the GDM group during the third trimester. The genera Lactiplantibacillus, Parvibacter, Prevotellaceae UCG001, and Vagococcus positively correlated with physical activity levels in GDM women in the second trimester. Similarly, the genus Victivallis exhibited a strong positive correlation with gravida and parity. On the contrary, the genus Bacteroides and Roseburia showed a negative correlation with omega-3 polyunsaturated fatty acids (PUFAs) in women without GDM in the third trimester. The study highlighted the multifaceted nature of GDM, involving a combination of lifestyle factors, dietary choices, and changes in gut microbiota composition. The findings emphasized the importance of considering these interconnected elements in understanding and managing gestational diabetes among Malaysian Malay women. Further exploration is essential to comprehend the mechanisms underlying this relationship and develop targeted interventions for effective GDM management.

Context Vitamin E, a well-known antioxidant with numerous positive effects on human health, encompasses tocotrienol-rich fraction (TRF), a natural variant abundant in palm oil.Objective This systematic review analyzed findings from randomized controlled trials published until 2022 to evaluate the health impacts of palm TRF.Data Sources A literature search was performed in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, OVID Medline, SCOPUS, and Web of Science from inception until December 2022. Thirty studies involving 2646 patients, including both healthy individuals and those with underlying conditions, were identified.Results This review shows palm TRF to be a promising natural supplement against inflammation and lipid peroxidation and that can significantly enhance overall health. Additionally, the study underscores the necessity for further research to ascertain the optimal dosage, formulation, and duration of supplementation, maximizing the potential health advantages.Conclusion This systematic review provides evidence supporting the health benefits associated with palm TRF.Systematic Review Registration PROSPERO registration no. CRD42020204070.

There are a large number of studies that have reported benefits of tocotrienol-rich fraction (TRF) in various populations with different health status. To date, no systematic reviews have examined randomized controlled trials (RCTs) on the effect of TRF supplementations specifically in patients with type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis aim to examine the changes in HbA1c (glycated hemoglobin), blood pressure, and serum Hs-CRP (C-reactive protein high sensitivity) levels at post-TRF supplementation. Online databases including PubMed, Scopus, OVID Medline, and Cochrane Central Register of Controlled Trials were searched from inception until March 2023 for RCTs supplementing TRF in patients with T2DM. A total of 10 studies were included in the meta-analysis to estimate the pooled effect size. The Cochrane Risk-of-Bias (RoB) Assessment Tool was utilized to evaluate the RoB in individual studies. The meta-analysis revealed that TRF supplementation at a dosage of 250-400 mg significantly decreased HbA1c (-0.23, 95% CI: -0.44, -0.02, P < 0.05, n = 754), particularly where the intervention duration is less than 6 mo (-0.47%, 95% CI: -0.90, -0.05, P < 0.05, n = 126) and where duration of diabetes is less than 10 y (-0.37, 95% CI: -0.68, -0.07, P < 0.05, n = 83). There was no significant reduction in systolic and diastolic blood pressure and serum Hs-CRP (P > 0.05). The present meta-analysis demonstrated that supplementing with TRF in patients with T2DM decreased HbA1c but does not decrease systolic and diastolic blood pressure and serum Hs-CRP.