Soil-transmitted helminth infections constitute a global affliction affecting people and livestock, resulting in a significant disease burden and economic losses in endemic regions. However, control has not been entirely successful and the problem is compounded by the development of resistance to available chemotherapy. Novel alternative compounds are urgently needed, encouraging the screening of largely plant-based sources for anthelmintic effects. Date palm fruit (Phoenix dactylifera) is a popular and nutritious food much coveted for its nutraceutical effect. There are convincing reports documenting the antibacterial, antiviral and antifungal effects of date palm fruit but evidence for any potential anthelmintic effect remains unclear. Here we conducted a systematic review of the published information through an electronic search using six scientific databases; SCOPUS, MEDLINE COMPLETE, OVID, EMBASE, WEB OF SCIENCE and CINAHL COMPLETE. Out of 58 studies that were initially identified only 2 manuscripts fitted our inclusion criteria. The first article reported on the anthelmintic effect of date palm fruit against the rodent nematodes Trichuris muris and Angiostrongylus cantonensis in vitro and in vivo while the second article was based only on in vivo assessment (with coconut) of the effect on the rodent cestode Hymenolepis microstoma. Our review revealed limited anecdotal reports of the anthelmintic effect of date palm fruit against parasitic helminths, however, the majority of reports were inconclusive due to mixed results, limited focus on date palm fruit and lack of any statistical analyses. Rigorous, systematic and fully controlled studies focusing on date palm fruit are needed to validate the anecdotal evidence.

The home remedy of taking honey along with a citrus juice of lemon, lime or calamansi to soothe sore throat has long been practiced in many cultures across the world since ancient times. This paper aims to systematically review the antibacterial effect of honey and citrus juice on Streptococcus pyogenes by means of a systematic search in EBSCOhost, Medline, Scopus and ISI Web of Science databases for reports of studies investigating the antibacterial effects of honey and citrus fruit juice on S. pyogenes. A total of 415 publications were initially identified out of which, 20 were finally chosen and reviewed by looking at the tittles, abstracts and fullpaper usingpre-determined inclusion and exclusion criteria in relation to honey (n=16) and citrus (n=4). The majority of the studies showed that both honey and citrus have significant antimicrobial effect on S. pyogenes. There are still not many available data though on the combined effect of honey and citrus on the bacterium. This knowledge gap offers an opportunity to investigate those effects with the purpose of supporting traditional practice with scientific evidences.

Background and Objective: Orphaned children face an increased risk of being malnourished. This study was aimed to explore knowledge and attitudes towards nutrition as well as nutritional practices and Body Mass Index (BMI) of adolescent residents of orphanages. Methodology: Five orphanage institutions in Selangor and Malacca were chosen for this study and 85 adolescents aged 13-18 years old were enrolled. Questionnaires concerning nutritional knowledge were administered in face-to-face interviews to prevent bias and to ensure questionnaire completion. Results: The results showed that out of the 85 subjects, 80% were orphans and 20% non-orphans. The majority of respondents were of normal weight (61.2%), while 2.4 and 4.7% were thin and severely thin, respectively. Meanwhile, 16.5% of subjects were overweight and 15.3% were obese. Fewer than 20% of respondents (14/85) were scored as having a “good” level of nutritional knowledge score but more than half had nutrition attitude and practice scores within the “good” range. Although no significant correlation was found between nutrition knowledge and attitude (rp = -0.043, p = 0.694) or knowledge and practice (rp = -0.222, p = 0.148), there was significant correlation between nutrition attitude and practice (rp=0.295, p = 0.006). Conclusion: Less than half of the total respondents obtained a “good” score for nutritional knowledge but the majority of the participants scored at the “good” level for attitude and practice. Although most respondents scored at the “good” level for nutritional practice, this outcome was not reflective of the situation as a whole, particularly given the “poor” scores for exercise and breakfast practices.

Cupping therapy is defined as a therapeutic treatment using evacuated cups being placed to intact or scarified skin to withdraw blood and interstitial fluid filled with causative pathological substances. Clinical practice guideline is crucial to assist in decision making during patient care and promote standardized care which helps to increase quality and patient outcome. Adherence to cupping practice guideline was considered low at 5.3% in prior study (Mahat & Rahman, 2020). Hence, this study aimed to explore barriers of cupping practitioners’ adherence to Malaysian cupping practice guideline. This qualitative study involved three cupping practitioners who agreed to semi-structured interviews. Several barriers of practice guideline use were identified using thematic analysis. Among these are increased cost, lack of practice resources, lack of time, inadequate knowledge on the guideline, lack of agreement, and lack of feeling expectancy. Furthermore, being surrender or tawakkal is notified as a newly emerged barrier from the analysis. Specific measures addressing those should be disseminated and implemented, such as to streamline educational training in enhancing guideline familiarity. Besides, it is essential to have reminder systems such as notification pop-out, email, face-to face session and management chain to assist in guideline use

Iron deficiency anaemia (IDA) is a global health problem. It is an indicator of poor nutrition and poor health. Based on the Al-Quran and prophetic Sunnah, dates are mentioned as a superfood that helps in the preservation of health. Therefore, we are evaluating the potential of using dates as a treatment for IDA from data published in various reports. The search was conducted for relevant articles published in four electronic indexed databases namely Medline, Ovid, Scopus, Biomed Central, and PubMed. Bibliographies of the screened studies and relevant reviews and manuscripts were also searched using Google scholar. The data reported involved systematic reviews and reports of studies that are according to the PRISMA guidelines. There were only three articles that discussed the effects of the use of dates in IDA. A significant increase was shown (p<0.05) in haematological parameters such as haemoglobin level, red blood cell count, packed cell volume and platelet count while no effect was shown on total white blood cell count, differential white blood cell and bone marrow (p>0.05). This systematic review identified limited reports that reported on the beneficial effects of dates in reducing IDA. There are several gaps in the available evidence, hence, further studies are needed to provide a comprehensive understanding on this matter.

Background: Immediately after tooth extraction, placing of dental implants has become an increasingly prevalent approach for bone preservation and treatment time reduction. This method not only reduces therapy time but also enhances esthetics by maintaining surrounding soft tissue. Objectives: Comparing and determining proof for the survival and achievement rates of implants in pristine and infected locations. Materials and Methods: An electronic search for papers released between April 2013 and December 2018 was performed on the PubMed website, Medline database. The titles and abstracts of these findings were read in order to recognize studies under inclusion and exclusion criteria. All review articles, case series and case reports have been excluded. In English only papers were made. Results: Originally 62 documents were made by the search strategy. The selection criteria included four trials. Manual search supplied additional records. Five studies have finally been included. Conclusion: This research suggested that after thorough debriding and use of the appropriate operating method, it could be feasible to place the implant immediately on infected sockets.

Purpose: To compare access to medicines in children living in poor households (income of USD1/person/day) between urbanised Klang Valley and rural East Coast of Peninsular Malaysia. Methods: A semi-structured interview was conducted with caregivers to determine demographics, access to medicines, knowledge, attitude and practice of parents in obtaining medicines for children. Results: There was no significant difference socio-demographically between poor households in Klang Valley (N = 58) and East Coast (N = 40). The study found that access to medicine for children (N = 325) in the households was adequate, where all households that reported illness in the children over the last 1 month and the last 6 month periods, obtained medicines and 99 % of the children were fully immunized. Qualitative analysis showed that poor households face several barriers in accessing medicines for their children such as financial, transportation, physical and attitudinal. Conclusion: Access to medicines for children living in poor households in both areas were similar and adequate. However, barriers to access remain and further studies are required. � Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, Benin City, 300001 Nigeria. All rights reserved.

Background: Many studies on biochemical and psychological variables have aimed to elucidate the association between aging and cognitive function. Demographic differences and protein expression have been reported to play a role in determining the cognitive capability of a population. Objective: This study aimed to determine the effect of age on the protein profile of Malay individuals and its association with cognitive competency. Methods: A total of 160 individuals were recruited and grouped accordingly. Cognitive competency of each subject was assessed with several neuropsychological tests. Plasma samples were collected and analyzed with Q Exactive HF Orbitrap. Proteins were identified and quantitated with MaxQuant and further analyzed with Perseus to determine differentially expressed proteins. PANTHER, Reactome, and STRING were applied for bioinformatics output. Results: Our data showed that the Malay individuals are vulnerable to the deterioration of cognitive function with aging, and most of the proteins were differentially expressed in concordance. Several physiological components and pathways were shown to be involved, giving a hint of a promising interpretation on the induction of aging toward the state of the Malays' cognitive function. Nevertheless, some proteins have shown a considerable interaction with the generated protein network, which provides a direction of focus for further investigation. Conclusion: This study demonstrated notable changes in the expression of several proteins as age increased. These changes provide a promising platform for understanding the biochemical factors affecting cognitive function in the Malay population. The exhibited network of protein-protein interaction suggests the possibility of implementing regulatory intervention in ameliorating Malay cognitive function.

Background. Impaired fasting glucose (IFG) poses a higher risk of diabetes. Honey has been reported to improve metabolic abnormalities including lowering hyperglycemia. This study is sought at determining the effect of Malaysian Kelulut honey (KH) on fasting glucose levels and metabolic parameters in IFG patients. Methods. This quasi-experimental intervention study of 30-day duration was conducted among 60 adult patients with IFG. They were allocated into taking 30g/day KH group (experimental group, n=30) and not taking KH group (control group, n=30). Body mass index (BMI), waist circumference, blood pressure (BP), fasting glucose, and lipid profile levels (total cholesterol, triglyceride, high-density lipoprotein, and low-density lipoprotein) were measured before and after treatment. Results. There was no significant difference in all measured variables at day 30 compared to day 1 within both groups. Similarly, all measured variables neither at day 1 nor at day 30 had shown a statistically significant difference between the groups. Conclusions. Daily intake of 30g KH for 30 days resulted in insignificant effect on fasting glucose, fasting lipid profiles, and other metabolic parameters in patients with IFG. Further studies that employ longer study duration are needed to ascertain the finding.

Nigella sativa (NS) is widely used in traditional medicine and several studies have been conducted to reveal NS effects on different medical disorders including hyperlipidemia. Since hyperlipidemia is a common risk factor for the development of cardiovascular illness. We evaluated the effects of NS supplementation on lipid profile in clinical trial performed among humans. A search on published studies was done by using databases including Scopus, PubMed, Google Scholar, Thomas Reuters Web of Science, and CINAHIL. Terms searched included "Nigella sativa, Black seed, Black cumin, Triglycerides, Cholesterol, Lipoproteins". Initially 432 articles were extracted. However, four hundred eighteen papers were unrelated, reviews, animal studies, combined and duplicated studies were excluded, and finally only fourteen articles were eligible for this review. After analysing 14 articles including 738 participants from different countries and nations. Results of these clinical trials revealed that Nigella sativa is effective to change the lipid profile significantly in different conditions. This systematic review revealed that Nigella sativa supplementation might be effective in hyperlipidemic control in humans and seems potential target of future drug for hyperlipidemic conditions. � 2017 Redhwan Ahmed Al-Naggar et al.

Ethnopharmacological relevance: Salvadora persica L. and Azadirachtaindica A.Juss. are listed within the most common sources of miswak or chewing stick that widely used among Western Asia and Muslim populations worldwide. Miswak use in conjunction with toothbrush (adjunctive) has become apparent among the adults. Furthermore, miswak has been reported to have mechanical and pharmacological activities, and benefits to the oral health, by many studies. Aim of the study: To assess the effectiveness of miswak in maintaining periodontal health among adults. Materials and methods: We searched for randomised controlled trials (RCTs) investigating the effect of miswak published in PubMed, EBSCOHOST (Dentistry & Oral Sciences), SCOPUS, and Cochrane Database for Systematic Review (CDSR) from inception to May 08, 2022. The primary outcomes of interest were changes in the periodontal health measured with plaque and gingivitis scores as well as subgingival bacteria load. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach while the estimates of effect were pooled using a random-effects model. Results: Ten eligible articles were identified, of which 9 could be analysed quantitatively. The remaining report was included as part of the qualitative analysis. The meta-analysis showed that miswak was comparable with the toothbrush in reducing the mean plaque score (p= 0.08, SMD: 0.39, and 95% CI: −0.05 to 0.83) and mean gingivitis score (p= 0.37, SMD: 0.13, and 95% CI: −0.16 to 0.43). Even higher certainty of evidence for the effect of miswak on mean plaque reduction on labial surface of anterior teeth. However, the adjunctive effect of miswak was significantly more superior for reducing plaque (p= 0.01, SMD: 0.68, and 95% CI: 0.14 to 1.22) and gingivitis score (p= 0.04, SMD: 0.66, and 95% CI: 0.03 to 1.29). Conclusions: Miswak effectively reduced plaque and gingivitis scores to a level comparable to toothbrush when used exclusively. Adjunctive miswak use was particularly effective in improving periodontal health. However, the included studies inadequately reported on the method of toothbrushing using miswak and the frequency of miswak use. Therefore, further clinical studies are recommended to explore on the advantages and proper method of miswak practice for optima outcome and safety.

Goat’s milk can be considered as one type of natural functional food due to its variety of nutritional benefits. Nowadays, the dairy milk production in Malaysia is highly focusing on cow’s milk compared to goat’s milk. However, the demand for goat’s milk is increasing especially among Muslims as it is considered as one of the foods which consumed by the Prophet Muhammad (pbuh). A cross-sectional study was conducted involving 221 residents in Pulau Langkawi, Kedah, Malaysia. This study showed that the practice of drinking goat’s milk among the local residents was still low; only 11.8% of the residents consumed goat’s milk daily and 40% chose goat’s milk in its powdered form. The main barriers to goat’s milk consumption included: not interested to consume goat’s milk (54%), unpleasant taste (51.3%) and non-staple food (50.8%). This study also found that knowledge (r2= 0.200, p = 0.003) and attitude (r2= 0.174, p<0.001) are positively correlated with goat’s milk consumption. In conclusion, further health intervention need to be done to promote the practice of drinking goat’s milk. With proper knowledge and positive attitude, the consumption of goat’s milk may improve the quality of life and sustain an optimal wellness and health throughout life.

Purpose: To investigate the incidence, characteristics and risk factors of adverse drug reactions (ADRs) in hospitalized children in a Malaysian hospital. Methods: Patients admitted to the Paediatric Department of Hospital Ampang in Kuala Lumpur, Malaysia were monitored for occurrence of ADRs by spontaneous reporting or daily review of their case notes. Characteristics of ADRs were categorised and ADRs were analysed for causality, severity and preventability. Multivariate analyses were performed to determine associations between certain selected risk factors and ADR occurrence. Results: In 423 paediatric patients admitted in Hospital Ampang (436 admissions), the ADR incidence rate was 8.0% (95% CI, 5 - 11%). The most commonly involved medications were systemic antibacterial drugs (77.4%). About 61.3% of the ADRs were of probable causality and 12.9% were definitely preventable. No severe ADRs were detected, with 41.9% being moderate and 58.1% being mild, based on a severity scale. Younger children (OR = 3.387, 95% CI, 1.377, 8.334) and the number of systemic antibacterial drugs given (OR = 1.469, 95% CI 1.201, 1.798) were potential risk factors associated with ADRs. Conclusion: ADRs occur at a significant rate in the Malaysian children admitted to the hospital studied. Further studies are needed to provide drug safety data for the paediatric population in Malaysia. � 2018 Ithnin M, Rani MDM, Latif ZA, Kani P, Syaiful A, Mohd TAMT, Aripin KNN.

Background: Students' perceptions of their learning environment, by defining its strengths and weaknesses, are important for continuous improvement of the educational environments and curriculum. Therefore, the aim of this study was to explore students' perceptions of their learning environment, among medical students in Malaysia. Various aspects of the education environment were compared between year levels and sex. Methods: This cross-sectional study was conducted at the Management and Science University, Shah Alam, Malaysia in 2012. A total number of 438 medical students participated in this study, and the response rate was 87.6%. Data were analyzed using SPSS. Comparisons of the mean scores of Dundee Ready Education Environment Measure (DREEM) subscales were calculated. The t-test was used to determine statistically significant differences. Results: The majority of the study participants were female, Malay, and from year 3 (68.7%, 65.3%, and 55.7%; respectively). Analysis of each of the 50 items of the DREEM inventory showed that 47 items scored ranged between 2.00 and 3.00, and three items scored below 2.00. These were identified as problem areas in this medical school that are required to be critically addressed. The overall score showed that the medical students' perceptions were positive. The students' perception toward educational environment was positive for all five DREEM subscales. Conclusion: The study found that, in general, the perceptions of the participants about the learning environment were positive. Nevertheless, the study also found there is a need for curriculum improvement in this school and identified priority areas for such improvement.

Paracetamol poisoning is a common presentation in paediatrics. Toxicity may cause hepatocellular injury, in certain cases progressing to fulminant liver failure. Young children appear less at risk of hepatotoxicity due to an increased metabolic capacity for paracetamol. A single dose of 150 mg/kg can cause hepatocellular damage. Children who ingest multiple supratherapeutic doses can accumulate significant concentrations and may suffer worse outcomes. Older children who intentionally overdose may also suffer worse outcomes, especially those who present late. The risk of hepatotoxicity after a single overdose can be predicted using a widely used nomogram, although it was derived from adult data. The cornerstone of management is administering the antidote N-acetylcysteine when hepatotoxicity is likely to occur. The National Poisons Information Service is available to be consulted at all hours. When severe poisoning is suspected, the child may require referral to a liver unit in view of possible liver transplantation.

Metabolic syndrome is a cluster of conditions that increase the risk of developing chronic diseases. This paper aims to assess the data on metabolic syndrome among indigenous Orang Asli in Malaysia. Searches were carried out using electronic databases of CINAHL, Medline, PubMed, and Scopus using predefined keywords. Cross-sectional studies of metabolic syndrome using any clinical diagnosis criteria among adult Orang Asli in Peninsular Malaysia included. Fifteen studies with these criteria were selected, five with metabolic syndrome studies. The general prevalence (weighted mean) of metabolic syndrome in Orang Asli was 26.3% (range: 12.0–39.8). Metabolic syndrome was more frequent in females (30.0%) than in males (19.3%). The most common components of metabolic syndrome were low HDL-C levels (41.0%) and hypertension (33.7%). For abdominal obesity, high triglycerides, and abnormal glycemia, the prevalence was; 24.6%, 21.5%, and 14.0%, respectively. Conclusively, the present systematic review brings us closer to an understanding of the prevalence of metabolic syndrome among this vulnerable population. The methodological differences among the studies published limit a joint analysis of their results. Nevertheless, finding from this review shows their high prevalence of the metabolic syndrome is comparable with other ethnic groups in Malaysia that requires immediate attention from all related parties.

Aging is a complex process characterized by progressive loss of functional abilities due to the accumulation of molecular damages. Metabolomics could offer novel insights into the predictors and mechanisms of aging. This cross-sectional study is aimed at identifying age-associated plasma metabolome in a Malay population. A total of 146 (90 females) healthy participants aged 28–69 were selected for the study. Untargeted metabolomics profiling was performed using liquid chromatography-tandem mass spectrometry. Association analysis was based on the general linear model. Gender-associated metabolites were adjusted for age, while age-associated metabolites were adjusted for gender or analyzed in a gender-stratified manner. Gender-associated metabolites such as 4-hydroxyphenyllactic acid, carnitine, cortisol, and testosterone sulfate showed higher levels in males than females. Deoxycholic acid and hippuric acid were among the metabolites with a positive association with age after being adjusted for gender, while 9(E),11(E)-conjugated linoleic acid, cortisol, and nicotinamide were negatively associated with age. In gender-stratified analysis, glutamine was one of the common metabolites that showed a direct association with age in both genders, while metabolites such as 11-deoxy prostaglandin F2β, guanosine monophosphate, and testosterone sulfate were inversely associated with age in males and females. This study reveals several age-associated metabolites in Malays that could reflect the changes in metabolisms during aging and may be used to discern the risk of geriatric syndromes and disorders later. Further studies are required to determine the interplay between these metabolites and environmental factors on the functional outcomes during aging.

Background: The greatest burden of disease in children lies in the developing world; however, previous reviews have suggested that few randomized controlled trials (RCTs) involving children take place in developing countries. Children in developing countries deserve the same standard of medicines as those in developed countries, i.e. appropriate medications for the specific diseases that occur. Objective: To elucidate published pediatric therapeutic RCTs that have taken place in the developing world and to determine whether they are appropriate for the major diseases occurring there, and to explore their approach to safety monitoring. Methods: A previously assembled database of pediatric RCTs published between 1996 and 2002, from journals indexed in MEDLINE, was analyzed. The main country of setting of the RCTs was categorized as having low, medium or high development status according to the Human Development Index (HDI). Articles were read to add the WHO International Classification of Diseases 10th Revision (ICD-10) category of the disease studied, the WHO Collaborating Centre for Drug Statistics Methodology Anatomical Therapeutic Chemical (ATC) classification system category of the main drug therapy studied, the source of funding, and ethical approval to the variables already recorded in the database. Results: One hundred and fifty-eight (22%) of the 733 RCTs analyzed took place in medium and low HDI (developing) countries. The disease areas studied seemed appropriate, with 89 (56%) of the 158 RCTs studying infectious and parasitic diseases. Ninety-nine (63%) RCTs from developing countries were trials of antiparasitic and anti-infective drugs. Compared with studies from high HDI countries, a significantly lower proportion of articles from medium and low HDI countries mentioned ethical committee or institutional review board approval, and safety monitoring. Only one paper from low and medium HDI countries mentioned the presence of a safety monitoring committee/data safety monitoring board. Conclusions: Published pediatric drug RCTs conducted in developing countries appear to study appropriate diseases but the results show that fewer RCTs are undertaken compared with the developed world. The standard of reporting for RCTs from developing countries needs attention to ensure that adequate information can be obtained, especially with regard to safety monitoring.

The paediatric population constitutes a much smaller proportion of COVID-19 patients and seems to be less severely affected. However, the massive numbers of COVID-19 infections mean that many children require treatment in hospital. In the concerted and wide-ranging effort to discover a safe and effective treatment for COVID-19, paediatric involvement is necessary. This review aims to identify leading potential drug treatments and vaccines for COVID-19 that are being investigated with children involved. Clinicaltrials.gov, WHO Trial Registry Platform (ICTRP) and RAPS COVID-19 vaccine tracker webportals were searched for clinical trials in phase 3 that involved children below 15 years of age. Any preliminary results released were searched online. The review found 25 phase 3 drug trials with paediatric participants and 2 vaccine trials. No preliminary findings were found. Remdesivir appears to be a leading candidate drug treatment and 2 vaccines candidates, inactivated nCoV-19 (Sinopharm) and ChAdOx1 (Oxford University), are recruiting children in large phase 3 trials. No treatments are currently licensed for COVID-19 but results from numerous trials are eagerly awaited.

Higher level of education is associated with better cognitive performance and lower risk of developing dementia. However, the effect of education on cognitive performance varies across different cognitive domains and in different populations. The aim of this study was to determine the relationship between education and performance of different cognitive domains among healthy Malay adults. A total of 53 individuals aged 29 to 77 years participated in a battery of neurophysiological tests consisting of Mini-Mental State Examination, Montreal Cognitive Assessment, digit span, visual reproduction and digit symbol speed test (DSST). Blood test was performed for each participant to obtain their biochemical profile. Educational level was divided into level 1 (PMR), level 2 (SPM), level 3 (STPM), level 4 (Diploma) and level 5 (Degree). Simple linear regression indicated that years of education was positively associated with scores of delayed visual reproduction (b=1.348, p=0.002) and DSST (b=3.257, p=0.012). However, scores of all the tests were not significantly different among different levels of education after controlling for age, gender and blood test profile by ANCOVA. Multiple linear regression analysis showed that MMSE score was associated with red cell distribution width (b=-0.628, p=0.005), age (b=-0.119, p<0.001) and there was interaction between high density lipoprotein (HDL) with age (b=0.047, p<001). MoCA score was associated with age (b=-0.121, p<0.001), gender (male compared to female, b=1.870, p=0.020) and HDL (b=1.681, p=0.047). Age was associated with backward digit span (b=-0098, p<0.001) and immediate visual reproduction (b=-0.348, p<0.001), resp. Delayed visual reproduction was associated with age (b=-0.323, p<0.001) and potassium level (b=-4.471, p=0.016). DSST was associated with age (b=-0.911, p<0.001) and alanine aminotransferase (b=-0.754, p=0.002). The lack of association between educational level and cognitive performance after adjusting for confounders in this study maybe due to multiple factors influencing cognitive performance and further studies with a larger sample size are needed to further identify the factors involved.