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Fulltext Identification of phenolic compounds in polyphenols-rich extract of Malaysian cocoa powder using the HPLC-UV-ESI-MS/MS and probing their antioxidant properties

Ali F, Ranneh Y, Ismail A, Esa NM

J Food Sci Technol, 2015 Apr;52(4):2103-11.
PMID: 25829590 DOI: 10.1007/s13197-013-1187-4

The antioxidant components of cocoa powder, which is rich in polyphenols, were isolated using column chromatography and high performance liquid chromatography. Polyphenolic compounds were then characterized by high-performance liquid chromatography/Ultraviolet and electronspray ionization-tandem mass spectrometry (HPLC-UV-/ESI-MS-MS). As a result, five phenolic compounds were detected. In this study we also investigated scavenging or the total antioxidant capacity (%) of cocoa polyphenol (CP) fractionated from cocoa powder extract. 114.0 mg/g of gallic acid -equivalent phenolics and 94.3 mg/g catechin- equivalent flavonoids were quantified in this extract. Their free radical-scavenging activity was assessed by 1,1-diphenyl-2-picrylhydrazyl radical (DPPH) assay, β-carotene bleaching test, and xanthine oxidase inhibitory activity (OX). Total antioxidant capacity (TAC) was further assessed against the myoglobin-induced oxidation of 6-hydroxy-2, 5, 7, 8-tetramethylchroman-2-carboxylic acid (ABTS) and expressed as Trolox equivalent. A high correlation between TAC and phenolic contents indicated that phenolic compounds from cocoa were a major contributor of antioxidant activity (0.967 ≤ r ≤ 1.00). CP extract had significantly (P
Terminal microdeletion of chromosome 18 in a Malaysian boy characterized with few features of typical 18q- deletion syndrome: a case report

Ismail A, Ahid F, Thong MK, Zakaria Z

J Med Case Rep, 2023 Jun 10;17(1):250.
PMID: 37296475 DOI: 10.1186/s13256-023-03984-0

BACKGROUND: The 18q- deletion syndrome is a rare congenital chromosomal disorder caused by a partial deletion of the long arm of chromosome 18. The diagnosis of a patient with this syndrome relies on the family medical history, physical examination, developmental assessment, and cytogenetic findings. However, the phenotype of patients with 18q- deletion syndrome can be highly variable, ranging from almost normal to severe malformations and intellectual disability, and normal cytogenetic findings are common, thus complicating the diagnosis. Interestingly, only few characteristic features of typical 18q- deletion syndrome were found in the patient, despite sharing the same critical region. To our knowledge, this is the first report of a Malaysian individual with 18q- terminal microdeletion diagnosed with microarray-based technology.
CASE PRESENTATION: Here we report a 16-year-old Malaysian Chinese boy, a product of a non-consanguineous marriage, who presented with intellectual disability, facial dysmorphism, high arched palate, congenital talipes equinovarus (clubfoot), congenital scoliosis, congenital heart defect, and behavioral problems. A routine chromosome analysis on 20 metaphase cells showed a normal 46, XY G-banded karyotype. Array-based comparative genomic hybridization was performed using a commercially available 244 K 60-mer oligonucleotide microarray slide according to the manufacturer's protocol. This platform allows genome-wide survey and molecular profiling of genomic aberrations with an average resolution of about 10 kB. In addition, multiplex ligation-dependent probe amplification analysis was carried out using SALSA MLPA kit P320 Telomere-13 to confirm the array-based comparative genomic hybridization finding. Array-based comparative genomic hybridization analysis revealed a 7.3 MB terminal deletion involving chromosome band 18q22.3-qter. This finding was confirmed by multiplex ligation-dependent probe amplification, where a deletion of ten probes mapping to the 18q22.3-q23 region was detected, and further multiplex ligation-dependent probe amplification analysis on his parents showed the deletion to be de novo.
CONCLUSION: The findings from this study expand the phenotypic spectrum of the 18q- deletion syndrome by presenting a variation of typical 18q- deletion syndrome features to the literature. In addition, this case report demonstrated the ability of the molecular karyotyping method, such as array-based comparative genomic hybridization, to assist in the diagnosis of cases with a highly variable phenotype and variable aberrations, such as 18q- deletion syndrome.
Anti-Proliferative Activity of Triterpenes Isolated from Clinicanthus nutans on Hep-G2 Liver Cancer Cells

Zakaria KN, Amid A, Zakaria Z, Jamal P, Ismail A

Asian Pac J Cancer Prev, 2019 Feb 26;20(2):563-567.
PMID: 30803221

Problem statement: Clinicanthus nutans has been used by Malaysian since long time ago. It is used to treat many diseases including cancer. Many studies carried out on its crude extract but no clear report on the specific secondary metabolites responsible for its nature in treating selected diseases. Objective: This study aims to confirm the practice carried out by many people on the usage of Clinicanthus nutans in treating cancer. Methods: C. nutans leaves were extracted by methanol. Thin layer chromatography was used to identify the suitable solvent for fractions separation. The fractions were then separated at larger volume using gravity column chromatography. Each fraction was tested on its anti-proliferative activity on Hep-G2 liver cancer cells by MTT assay. The phytochemical screening was carried out to identify the bioactive compound based on qualitative analysis. Results: The fraction 2 (F2) of C. nutans showed the lowest IC50 value of 1.73 μg/ml against Hep-G2 cancer cells, and it is identified as triterpenes. Conclusion: The fraction F2 identified as triterpenes isolated from C. nutans has potential as an anti-proliferative agent against liver cancer.
Benzodiazepines for Treatment-Resistant Major Depressive Disorder and Obsessive-Compulsive Disorder With Comorbid Mega Cisterna Magna

Ismail A, Ab Razak A, Sayuti KA, Phoa PKA

Cureus, 2023 Oct;15(10):e46670.
PMID: 37942372 DOI: 10.7759/cureus.46670

This article discusses the case of an adult woman with comorbid major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Due to her poor response to initial treatment regimens, a brain computed tomography (CT) was performed, revealing mega cisterna magna (MCM). Subsequently, she responded well to the addition of lorazepam, a benzodiazepine, along with fluvoxamine and quetiapine XR. The clinical significance of MCM and MDD-OCD remains partially understood. Thus, this case report aims to contribute to the literature and review the treatment of benzodiazepines in relation to MCM, MDD, and OCD comorbidities.
Fulltext Exposure of the endangered Milky stork population to cadmium and lead via food and water intake in Kuala Gula Bird Sanctuary, Perak, Malaysia

Rahman F, Ismail A, Omar H, Hussin MZ

Toxicol Rep, 2017;4:502-506.
PMID: 28959680 DOI: 10.1016/j.toxrep.2017.09.003

The Milky stork is listed as an endangered species endemic to the Southeast Asia region. In Malaysia, the population is currently being reintroduced back into the wild. However, the increase of anthropogenic activity throughout the coastal area might expose the population to hazardous chemicals such as heavy metals. This study highlights the contamination of cadmium (Cd) and lead (Pb) in the Milky stork's diet. Additionally, this is the first time an integrated exposure model being used to assess heavy metal exposure risk to the population. Lead level (5.5-7.98 mg kg-1) in particular was relatively high compared to Cd (0.08-0.33 mg kg-1). This was probably related to the different niches occupied by the species in the aquatic environment. The results further show that the predicted exposure doses (through intake of both food and water) for all metals are much lower than the Tolerable Daily Intake (TDI) values. The total exposure dose for Cd was 0.11 mg kg-1 d-1 with TDI value of 0.54 mg kg-1 d-1 while Pb total exposure dose was 0.31 mg kg-1 d-1 with TDI value of 0.64 mg kg-1 d-1. Several possible factors that could lead to the observed pattern were discussed. In conclusion, there is an urgent need to improve the current habitat quality to protect the endangered species. The authors also emphasized on the protection of remaining Milky stork's habitats i.e. mudflats and mangroves and the creation of buffer zone to mitigate the negative impacts that may arise from pollution activity.
Isolation and characterization of a mo -reducing bacterium

Ghani B, Takai M, Hisham NZ, Kishimoto N, Ismail AK, Tano T, et al.

Appl Environ Microbiol, 1993 Apr;59(4):1176-80.
PMID: 16348915

A Mo -reducing bacterium (strain 48), which grew on medium supplemented with 200 mM Mo, was isolated from stream water obtained from Chengkau, Malaysia. The chemical properties of strain 48 conform to the characteristics of Enterobacter cloacae. Under anaerobic conditions in the glucose-yeast extract medium containing phosphate ion (2.9 mM) and Mo (10 mM), the bacterium reduced Mo to form molybdenum blue. Approximately 27% of Mo added to the medium was reduced after 28 h of cultivation. The reduction of Mo with glucose as an electron donor was strongly inhibited by iodoacetic acid, sodium fluoride, and sodium cyanide, suggesting an involvement of the glycolytic pathway and electron transport in Mo reduction. NADH and N,N,N',N' -tetramethyl-p-phenylenediamine served as electron donors for Mo reduction. When NADH was used as an electron donor, at first cytochrome b in the cell extract was reduced, and then molybdenum blue was formed. Sodium cyanide strongly inhibited Mo reduction by NADH (5 mM) but not the reduction of cytochrome b in the cell extract, suggesting that the reduced component of the electron transport system after cytochrome b serves as an electron donor for Mo reduction. Both ferric and stannous ions strongly enhanced the activity of Mo reduction by NADH.
Fulltext Stimulatory effects of polysaccharide fraction from Solanum nigrum on RAW 264.7 murine macrophage cells

Razali FN, Ismail A, Abidin NZ, Shuib AS

PLoS One, 2014;9(10):e108988.
PMID: 25299340 DOI: 10.1371/journal.pone.0108988

The polysaccharide fraction from Solanum nigrum Linne has been shown to have antitumor activity by enhancing the CD4+/CD8+ ratio of the T-lymphocyte subpopulation. In this study, we analyzed a polysaccharide extract of S. nigrum to determine its modulating effects on RAW 264.7 murine macrophage cells since macrophages play a key role in inducing both innate and adaptive immune responses. Crude polysaccharide was extracted from the stem of S. nigrum and subjected to ion-exchange chromatography to partially purify the extract. Five polysaccharide fractions were then subjected to a cytotoxicity assay and a nitric oxide production assay. To further analyze the ability of the fractionated polysaccharide extract to activate macrophages, the phagocytosis activity and cytokine production were also measured. The polysaccharide fractions were not cytotoxic, but all of the fractions induced nitric oxide in RAW 264.7 cells. Of the five fractions tested, SN-ppF3 was the least toxic and also induced the greatest amount of nitric oxide, which was comparable to the inducible nitric oxide synthase expression detected in the cell lysate. This fraction also significantly induced phagocytosis activity and stimulated the production of tumor necrosis factor-α and interleukin-6. Our study showed that fraction SN-ppF3 could classically activate macrophages. Macrophage induction may be the manner in which polysaccharides from S. nigrum are able to prevent tumor growth.
Fulltext Phytochemicals and Medicinal Properties of Indigenous Tropical Fruits with Potential for Commercial Development

Khoo HE, Azlan A, Kong KW, Ismail A

Evid Based Complement Alternat Med, 2016;2016:7591951.
PMID: 27340420 DOI: 10.1155/2016/7591951

Hundreds of fruit-bearing trees are native to Southeast Asia, but many of them are considered as indigenous or underutilized. These species can be categorized as indigenous tropical fruits with potential for commercial development and those possible for commercial development. Many of these fruits are considered as underutilized unless the commercialization is being realized despite the fact that they have the developmental potential. This review discusses seven indigenous tropical fruits from 15 species that have been identified, in which their fruits are having potential for commercial development. As they are not as popular as the commercially available fruits, limited information is found. This paper is the first initiative to provide information on the phytochemicals and potential medicinal uses of these fruits. Phytochemicals detected in these fruits are mainly the phenolic compounds, carotenoids, and other terpenoids. Most of these phytochemicals are potent antioxidants and have corresponded to the free radical scavenging activities and other biological activities of the fruits. The scientific research that covered a broad range of in vitro to in vivo studies on the medicinal potentials of these fruits is also discussed in detail. The current review is an update for researchers to have a better understanding of the species, which simultaneously can provide awareness to enhance their commercial value and promote their utilization for better biodiversity conservation.
Fulltext Antiatherosclerotic Effect of Canarium odontophyllum Miq. Fruit Parts in Rabbits Fed High Cholesterol Diet

Shakirin FH, Azlan A, Ismail A, Amom Z, Yuon LC

Evid Based Complement Alternat Med, 2012;2012:838604.
PMID: 22811751 DOI: 10.1155/2012/838604

The effect of C. odontophyllum (CO) fruit parts was investigated in hypercholesterolemic rabbits. Forty-nine rabbits, which were randomly divided into seven groups of seven animals (n = 7), received a diet containing different parts of CO fruit parts for 8 weeks. The groups were as follows: (1) normal diet: NC group and (2) hypercholesterolemic diet: PC, HS (10 mg/kg/day simvastatin), HPO (20 g kg(-1) oil extracted from the pulp of CO), HKO (20 g kg(-1) oil extracted from the kernel of CO), HF (50 g kg(-1) fullfat pulp of CO), and HD (50 g kg(-1) defatted pulp of CO). Among these groups, rabbits receiving defatted pulp of CO showed the greatest cholesterol lowering effect as it had reduced plasma LDL-C, TC, and thiobarbiturate reactive substance (TBARS) levels as well as atherosclerotic plaques. The presence of high dietary fiber and antioxidants activity are potential factors contributing to the cholesterol lowering effect. Consequently, these results indicate the potential use of CO defatted pulp as a cholesterol lowering and antioxidant agent.
Fulltext Autonomic Nervous System Mediates the Hypotensive Effects of Aqueous and Residual Methanolic Extracts of Syzygium polyanthum (Wight) Walp. var. polyanthum Leaves in Anaesthetized Rats

Ismail A, Mohamed M, Sulaiman SA, Wan Ahmad WA

Evid Based Complement Alternat Med, 2013;2013:716532.
PMID: 24454508 DOI: 10.1155/2013/716532

Syzygium polyanthum (Wight) Walp. var. polyanthum leaves are consumed as a traditional Malay treatment of hypertension. This study investigates hypotensive potential of aqueous (AESP) and residual methanolic (met-AESP) extracts of S. polyanthum leaves and possible involvement of autonomic receptors. AESP and met-AESP (20 to 100 mg/kg) were intravenously administered into anaesthetized Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats. Blood pressure and heart were monitored for 20 min. AESP and met-AESP induced significant dose-dependent hypotension, but only 100 mg/kg AESP caused mild bradycardia (n = 5). AESP-induced hypotension was more potent than that of met-AESP in WKY. AESP has a faster onset time than that of met-AESP in both WKY and SHR. However, met-AESP-induced hypotension was more sustained than that of AESP in SHR. Blockages of autonomic ganglion and α -adrenergic receptors using hexamethonium and phentolamine (n = 5 for each group) partially attenuated AESP-induced hypotension, suggesting involvement of α -adrenergic receptors. Blockages of autonomic ganglion, β -adrenergic, cholinergic receptors, and nitric oxide production using hexamethonium, propranolol, atropine, and N- ω -nitro-l arginine methyl ester (L-NAME) (n = 5 for each group) partially attenuated met-AESP-induced hypotension, suggesting involvement of β -adrenergic and cholinergic receptors via nitric oxide production.
Mechanism Linking Cigarette Pack Factors, Point-of-Sale Marketing and Individual Factors With Smoking Intention Among School-Going Adolescents

Jetly K, Ismail A, Hassan N, Mohammed Nawi A

J Public Health Manag Pract, 2024 Sep 05.
PMID: 39236215 DOI: 10.1097/PHH.0000000000001960

CONTEXT: Tobacco usage accounts for one of the most preventable causes of death.
OBJECTIVE: This study aimed to explore mechanisms linking cigarette pack factors, point-of-sale marketing, and individual factors (psychological reactant trait) to predict smoking intention among school-going adolescents.
DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional study conducted among 6 urban secondary schools. A pretested and validated self-administered questionnaire was used. Data analysis for structural equation modeling was done using SMART-PLS v3.2.8.
MAIN OUTCOME MEASURE: The main outcome measure was to determine the direct and indirect effects of cigarette pack factors, point-of-sale marketing, and individual factors (psychological reactant trait) to predict smoking intention among school-going adolescents in a theory-based model.
RESULTS: A total of 386 adolescents fulfilling the inclusion criteria participated. Pictorial warning message reactance (β = .153, P ≤ .001), pack receptivity of conventional pack (β = .297, P = .004), and psychological reactant trait (β = .174, P ≤ .001) were positively related to smoking intention. Pictorial warning negative affect (β = -.153, P = .001) was negatively related to smoking intention. The psychological reactant trait was positively related to message reactance (β = .340, P ≤ .001). However, recall exposure to point-of-sale marketing and pack appraisal of conventional pack was not positively related to smoking intention (β = .038, P = .215 and β = -.026, P = .39, respectively). Pictorial warning message reactance also positively mediates the relationship between psychological reactant trait and smoking intention (β = 0.05, p = .001). The model has strong predictive power.
CONCLUSION: In conclusion, cigarette pack factors and psychological reactant traits are essential in predicting smoking intention. Hence, policymakers should consider these factors in developing smoking policies.
TolC facilitates the intracellular survival and immunomodulation of Salmonella Typhi in human host cells

Hussain A, Ong EBB, Balaram P, Ismail A, Kien PK

Virulence, 2024 Dec;15(1):2395831.
PMID: 39185619 DOI: 10.1080/21505594.2024.2395831

Salmonella enterica serovar Typhi (S. Typhi) causes typhoid fever, a systemic infection that affects millions of people worldwide. S. Typhi can invade and survive within host cells, such as intestinal epithelial cells and macrophages, by modulating their immune responses. However, the immunomodulatory capability of S. Typhi in relation to TolC-facilitated efflux pump function remains unclear. The role of TolC, an outer membrane protein that facilitates efflux pump function, in the invasion and immunomodulation of S. Typhi, was studied in human intestinal epithelial cells and macrophages. The tolC deletion mutant of S. Typhi was compared with the wild-type and its complemented strain in terms of their ability to invade epithelial cells, survive and induce cytotoxicity in macrophages, and elicit proinflammatory cytokine production in macrophages. The tolC mutant, which has a defective outer membrane, was impaired in invading epithelial cells compared to the wild-type strain, but the intracellular presence of the tolC mutant exhibited greater cytotoxicity and induced higher levels of proinflammatory cytokines (IL-1β and IL-8) in macrophages compared to the wild-type strain. These effects were reversed by complementing the tolC mutant with a functional tolC gene. Our results suggest that TolC plays a role in S. Typhi to efficiently invade epithelial cells and suppress host immune responses during infection. TolC may be a potential target for the development of novel therapeutics against typhoid fever.
Fulltext Retrospective review of dot enzyme immunoassay test for typhoid fever in an endemic area

Jackson AA, Ismail A, Ibrahim TA, Kader ZS, Nawi NM

Southeast Asian J Trop Med Public Health, 1995 Dec;26(4):625-30.
PMID: 9139364

Typhoid fever remains a common problem in Malaysia, but for its diagnosis both blood culture and the Widal test have drawbacks. A dot enzyme immunoassay (EIA) has been developed which detects IgM and IgG antibodies to a specific 50 kDa outer membrane protein on Salmonella typhi. This study was performed among outpatients attending the university hospital in Kelantan, a state on the east coast of Peninsular Malaysia where typhoid is endemic. The dot EIA was done on 149 outpatients of all ages in whom typhoid was suspected. Of these, 60 were not analysable due to insufficient data. The other 89 were retrospectively classed as typhoid (total = 21), or not typhoid (total = 68). The criteria for diagnosis of typhoid was either, blood culture was positive, or with blood culture negative, temperature was at least 38 degrees C and Widal O and/or H titer greater than or equal to 1/160. We then compared the diagnosis with the EIA result. For the result where either IgM or IgG was positive, sensitivity was 90%, specificity 91% and negative predictive value 97%. For IgM positive, specificity was 100%. But the specificity of IgG positive alone was reduced by six false positives, which were probably due to persistence of IgG after acute infection. Other cases were found where IgG positive alone appeared in the first week of typhoid fever, probably due to rapid response in a second or subsequent infection. We also found that IgM-producing patients were significantly younger than those showing IgG alone positive.
Study site: Community Medicine clinic, Accident & emergency department, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
The reliability and validity of the Malay version of the 18-item audit of Diabetes Dependent Quality of Life (the Malay ADDQOL) questionnaire

Kamarul Imran M, Ismail AA, Naing L, Wan Mohamad WB

Southeast Asian J Trop Med Public Health, 2007 Mar;38(2):398-405.
PMID: 17539293

The objective of this study was to examine the reliability and validity of the Malay version of the 18-item Audit of Diabetes Dependent Quality of Life (the Malay ADDQOL). Patients with type 2 diabetes mellitus who fulfilled the inclusion criteria were systematically selected. The Malay ADDQOL linguistically validated from the 18-item English version ADDQOL was self-administered twice at a 1-week interval. Two hundred eighty-eight respondents were included in the study. Analysis involved checking the feasibility, floor and ceiling effects, internal consistency, test-retest reliability and factor analysis. Item means and standard deviations fulfilled the Likert scale assumptions. The Cronbach's alpha was 0.943 (lower bound of the 95% CI of 0.935) and the intraclass correlation coefficient was 0.81 (95% CI from 0.72 to 0.87). Exploratory one factor analysis showed factor loadings above 0.5 for all the 18 items. The Malay ADDQOL has acceptable linguistic validity. It is feasible, has excellent reliability, content, construct validity, and is recommended to be used among Malay-speaking diabetic patients.
Antimicrobial effects of psidium guajava extract as one mechanism of its antidiarrhoeal action

Lutterodt GD, Ismail A, Basheer RH, Baharudin HM

Malays J Med Sci, 1999 Jul;6(2):17-20.
PMID: 22589684

A morphine-like spasmolytic action (not naloxone reversible; involving the inhibition of acetylcholine release) and also effects on the transmural transport of electrolytes (Na(+) and K(+)) and water have been reported as possible modes of the antidiarrhoeal action of polar fractions of Psidium guajava leaf extractives. The objective for this study was to verify if the reported modes of the antidiarrhoeal action should be broadened to include direct antimicrobial actions on some of the more common bacteria known to cause toxin-induced acute diarrhoea. Serial dilutions of a water-soluble, freeze-dried methanolic extract were tested on 10 such organisms, grown separately on nutrient agar plates, to determine the minimum inhibitory concentration (MIC) for each of these bacteria. These included the causative agents for (i) enteric fever (Salmonella typhi, Salmonella paratyphi A, Salmonella paratyphi B and Salmonella paratyphi C), (ii) food poisoning (Salmonella typhimurium and Staphylococcus aureus), (iii) dysentery (Shigella dysenteriae, Shigella flexneri and Shigella sonnei), and (iv) cholera (Vibrio cholerae). The growth of all these organisms was inhibited at the MIC of 10mg/ml of the extract, which is equivalent to 2.5μg/ml of active extractable flavonoids. The most sensitive organisms (MIC = 1mg/ml) were Staphylococcus aureus, Vibrio cholerae and Shigella flexneri.
Stress Among the Adult Population During COVID-19 Pandemic in Kedah, Malaysia: Association Between Sociodemographics and the Movement Control Order Period

Ismail A, Tengku Ismail TA, Mohamad Marzuki MF

Cureus, 2023 Oct;15(10):e47619.
PMID: 38022193 DOI: 10.7759/cureus.47619

Background The COVID-19 pandemic has led to a significant increase in the prevalence of stress worldwide. However, the extent and factors associated with psychological distress during COVID-19 among the local population in Kedah, Malaysia, have not been adequately explored. This study aimed to determine the prevalence and factors associated with stress among the adult population in Kedah, Malaysia, during the COVID-19 pandemic. Materials and methods We conducted a cross-sectional study using a retrospective record review. A simple random sampling was applied among the adult population of Kedah who were screened for mental health well-being from January 2021 until March 2022. A proforma checklist that consists of sociodemographic and clinical factors and the date of screening was used to collect the data. A descriptive and multiple logistic regression was conducted, and analysis was done by SPSS version 26 (IBM Inc., Armonk, New York). The dependent variables were the presence of stress incorporated self-reported symptoms ranging from mild to very severe. The independent variables were sociodemographic, clinical factors, and movement control order period, which refers to the period when the state of Kedah experienced all the different phases of movement control order (MCO), which were from 1 January 2021 until 28 June 2021. Results In total, 562 adults were included. The mean age was 31.75 years, and the majority were female (69.6%). The prevalence of stress was 45.7% (95% CI 41.6%, 49.8%), with a total of 257 people. The majority of them did not have stress, consisting of 305 people (54.3%), followed by 69 people (12.3%) who reported severe stress, 67 people (11.9%) who reported moderate, 66 people (11.7%) who reported mild, and 55 people (9.8%) who reported very severe stress. The significant factor associated with stress among the adult population in Kedah, Malaysia, during the COVID-19 pandemic was the female gender (Adj OR 3.035 95% CI: 2.007 to 4.591, p-value <0.001). Being unemployed (Adj OR 2.171 95% CI: 1.480 to 3.185, p-value <0.001) and being under movement control order period was also associated with stress (Adj OR 0.383 95% CI: 0.264 to 0.555, p-value <0.001). Conclusion The prevalence of stress among the adult population during the COVID-19 pandemic in Kedah was 45.7%, with a total of 257 people, higher than other studies. Being female and unemployed was associated with stress, while the movement control order period was a protective factor against stress. Preventive strategies should be tailored based on the vulnerabilities of these groups, such as the development of more effective community-based interventions for safeguarding the mental health of the general public during future pandemics.
Fulltext Deletion of Salmonella enterica serovar Typhi tolC reduces bacterial adhesion and invasion toward host cells

Hussain A, Ong EBB, Balaram P, Ismail A, Kien PK

Front Microbiol, 2023;14:1301478.
PMID: 38029101 DOI: 10.3389/fmicb.2023.1301478

BACKGROUND: S. Typhi is a Gram-negative bacterium that causes typhoid fever in humans. Its virulence depends on the TolC outer membrane pump, which expels toxic compounds and antibiotics. However, the role of TolC in the host cell adhesion and invasion by S. Typhi is unclear.
OBJECTIVE: We aimed to investigate how deleting the tolC affects the adhesion and invasion of HT-29 epithelial and THP-1 macrophage cells by S. Typhi in vitro.
METHODS: We compared the adhesion and invasion rates of the wild-type and the tolC mutant strains of S. Typhi using in vitro adhesion and invasion assays. We also measured the expression levels of SPI-1 genes (invF, sipA, sipC, and sipD) using quantitative PCR.
RESULTS: We found that the tolC mutant showed a significant reduction in adhesion and invasion compared to the wild-type strain in both cell types. We also observed that the expression of SPI-1 genes was downregulated in the tolC mutant.
DISCUSSION: Our results suggest that TolC modulates the expression of SPI-1 genes and facilitates the adhesion and invasion of host cells by S. Typhi. Our study provides new insights into the molecular mechanisms of S. Typhi pathogenesis and antibiotic resistance. However, our study is limited by the use of in vitro models and does not reflect the complex interactions between S. Typhi and host cells in vivo.
Fulltext Effectiveness of traditional Malaysian vegetables (ulam) in modulating blood glucose levels

Bachok MF, Yusof BN, Ismail A, Hamid AA

Asia Pac J Clin Nutr, 2014;23(3):369-76.
PMID: 25164446 DOI: 10.6133/apjcn.2014.23.3.01

Ulam refers to a group of traditional Malaysian plants commonly consumed as a part of a meal, either in the raw form or after a short blanching process. Many types of ulam are thought to possess blood glucose-lowering properties, but relatively little is known on the effectiveness of ulam in modulating blood glucose levels in humans. This review aims to systematically evaluate the effectiveness of ulam in modulating blood glucose levels in humans. A literature review was conducted using multiple databases with no time restriction. Eleven studies were retrieved based on a priori inclusion and exclusion criteria. In these 11 studies, only Momordica charantia, locally known as "peria katak", was extensively studied, followed by Centella asiatica, locally known as "daun pegaga", and Alternanthera sessilis, locally known as "kermak putih". Of the 11 studies, 9 evaluated the effectiveness of M. charantia on blood glucose parameters, and 7 of which showed significant improvement in at least one parameter of blood glucose concentration. The remaining 2 studies reported nonsignificant improvements in blood glucose parameters, despite having high-quality study design according to Jadad scale. None of the studies related to C. asiatica and A. sessilis showed significant improvement in blood glucose-related parameters. Current clinical evidence does not support the popular claim that ulam has glucose-lowering effects, not even for M. charantia. Hence, further clinical investigation is needed to verify the glucose modulation effect of M. charantia, C. asiatica, and A. sessilis.
Fulltext Community practices of face mask use and associated knowledge and attitude in a Malaysian town during the COVID-19 pandemic

Jalaluddin HA, Burud IAS, Yew RPC, Loh XT, Tan QGJ, Nathan N, et al.

Ghana Med J, 2023 Jun;57(2):102-111.
PMID: 38504755 DOI: 10.4314/gmj.v57i2.4

OBJECTIVES: Among the vital measures to effectively curb the incidence of COVID-19 is the use of face masks. Little is known about what people understand and how they perceive and use face masks. This study aimed to determine the community's knowledge, attitude, and practice on the correct use of face masks.
DESIGN: A cross-sectional study.
SETTING: The study was carried out in Seremban 2, Malaysia using a self-administered questionnaire adapted from validated questionnaires of two previous studies.
PARTICIPANTS: Through opportunistic sampling, three hundred and ninety-two literate adults (above 18) residing in Seremban 2, Malaysia, participated in this study.
MAIN OUTCOME MEASURE: Knowledge, attitude, and practice scores were assessed among the participants.
RESULTS: Three hundred seventy (94.4%) respondents demonstrated satisfactory knowledge. A satisfactory attitude score was achieved by 349 (89%) respondents, while 281 (71.7%) achieved a satisfactory practice score. Better knowledge was significantly associated with college or university education (p=0.028). Female gender (p=0.011) and college or university education (p=0.043) were significantly associated with better practice (p<0.05). Significant but weak to fair correlations between knowledge, attitude and practice were observed.
CONCLUSION: Overall, there was satisfactory knowledge, attitude, and practice of face mask use among the Seremban 2 adult population in Malaysia. However, future public health education targeted toward the use of face masks requires more emphasis on proper usage and disposal to translate good knowledge into a good attitude and practice of face mask use to ensure the effectiveness in curbing the spread of infection.
FUNDING: None declared.
The influence of omega-3 supplementation on vitamin D levels in humans: a systematic review and dose-response meta-analysis of randomized controlled trials

Alhabeeb H, Kord-Varkaneh H, Tan SC, Găman MA, Otayf BY, Qadri AA, et al.

Crit Rev Food Sci Nutr, 2020 Dec 25.
PMID: 33356450 DOI: 10.1080/10408398.2020.1863905

BACKGROUND: Inconsistencies exist with regard to the influence of omega-3 supplementation on 25-hydroxyvitamin D (25(OH)D) levels, which could be attributed to many factors, such as the duration and dose of omega-3 supplementation, and individuals' baseline 25(OH)D levels. Therefore, to address the inconsistencies, we conducted a systematic review and dose-response meta-analysis to accurately determine the effect of omega-3 supplementation on 25(OH)D levels in humans.
METHODS: We performed a comprehensive literature search in Web of Science, PubMed/Medline, Scopus, and Embase databases from inception up to January 2020. We included only randomized controlled trials (RCTs). We used weighted mean difference (WMD) with 95% confidence interval (CI) to assess the influence of omega-3 supplementation on serum 25(OH)D levels using the random-effects model.
RESULTS: Our pooled results of 10 RCTs demonstrated an overall significant increase in 25(OH)D levels following omega-3 intake (WMD = 3.77 ng/ml, 95% CI: 1.29, 6.25). In addition, 25(OH)D levels were significantly increased when the intervention duration lasted >8 weeks and when the baseline serum 25(OH)D level was ˂20 ng/ml. Moreover, omega-3 intake ≤1000 mg/day resulted in higher 25(OH)D levels compared to omega-3 intake >1000 mg/day.
CONCLUSION: In conclusion, omega-3 supplementation increased 25(OH)D concentrations, particularly with dosages ≤1000 mg/day and intervention durations >8 weeks.

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