METHODS: The leaves of P. betle were extracted with solvents of varying polarities (water, methanol, ethyl acetate and hexane) and their phenolic and flavonoid content were determined using colorimetric assays. Phenolic composition was characterized using HPLC. Antioxidant activities were measured using FRAP, DPPH, superoxide anion, nitric oxide and hyroxyl radical scavenging assays. Biological activities of the extracts were analysed using MTT assay and antioxidant enzyme (catalase, superoxide dismutase, glutathione peroxidase) assays in MCF-7 cells.
RESULTS: Overall, the ethyl acetate extract showed the highest ferric reducing activity and radical scavenging activities against DPPH, superoxide anion and nitric oxide radicals. This extract also contained the highest phenolic content implying the potential contribution of phenolics towards the antioxidant activities. HPLC analyses revealed the presence of catechin, morin and quercetin in the leaves. The ethyl acetate extract also showed the highest inhibitory effect against the proliferation of MCF-7 cells (IC50=65 μg/ml). Treatment of MCF-7 cells with the plant extract increased activities of catalase and superoxide dismutase.
CONCLUSIONS: Ethyl acetate is the optimal solvent for the extraction of compounds with antioxidant and anti-proliferative activities. The increased activities of catalase and superoxide dismutase in the treated cells could alter the antioxidant defense system, potentially contributing towards the anti-proliferative effect. There is great potential for the ethyl acetate extract of P. betle leaf as a source of natural antioxidants and to be developed as therapeutics in cancer treatment.
MATERIALS AND METHODS: This cross-sectional study is conducted at the Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) clinic of Hospital Universiti Sains Malaysia. The forward and backward translation of the OSA- 18 questionnaire into the Malay language (Malay OSA-18) was performed and tested for content and face validity. The questionnaire's internal validity and reliability were tested using Pearson's correlation, Cronbach α and inter-reliability coefficient tests. The psychometric properties (validity, reliability and reproducibility) were assessed.
RESULTS: We observed 84 patients ranging from six months up to 12 years of age. The mean age was 8 years old, and 63.1% were male patients. Among the samples, 96.4% presented with palatine tonsillar enlargement, and 84.5% presented with adenoid tonsillar enlargement. Based on the questionnaire the patient's caregiver answered, Pearson's correlation demonstrated that all the symptom scales correlate and measure the same things. The Cronbach's α coefficient value for each symptom scale was acceptable, within 0.6-0.8. The total Cronbach's α coefficient value was 0.89. The test-retest evaluation was excellent, with the value of intraclass correlation (ICC) more than 0.90.
CONCLUSION: The Malay version of the OSA-18 questionnaire is equivalent to the original English version. It is an effective tool to assess the paediatric OSA patient's symptoms and quality of life based on the obtained validity, reliability and reproducibility values. Therefore, it is recommended to be a screening tool in daily practice.