Male-to-female transgenders are discriminated in Malaysia due to their gender expression, their involvement in the sex trade, and the high prevalence of HIV infection in this community. They are burdened by many health issues including HIV and sexually transmitted diseases, psychiatric problems, substance abuse, and complications resulting from feminizing procedures. Although majority of the transgender community is Muslim, many of them are far from religious guidance due to discrimination and fear towards criminalization. Efforts are needed to tackle the risks and vulnerability in health issues in the mak nyah community. This paper discusses the health issues faced by transgenders in Malaysia, and also describes an integrated method in helping the transgender community. � 2017 American Scientific Publishers All rights reserved.

Atherosclerosis in cardiovascular disease (CVD) is a growing health problem, especially in developing countries. Hyperlipidemia is known as a dominant risk factor for the development of atherosclerosis. This study was designed to investigate the effects of Eurycoma Longifolia (EL) also known as Malaysian Ginseng/Tongkat Ali on the testosterone level, biochemical changes of lipid profile and intima media thickness (IMT) in rats fed on high-fat diet. Twenty young, adult male Sprague-Dawley (SD) rats were housed for 12 weeks. After one week of acclimatization, they were randomly divided into four groups of 5 animals each and treated for 12 weeks as follow: Group ND was given only normal diet, group NDEL was given normal diet and EL extracts (15mg/kg) dissolved in distilled water, group HFD was given only high fat diet and group HFDEL was given high fat diet and EL extracts (15mg/kg). Rats which were treated with EL (NDEL and HFDEL) showed a significant increase (p < 0.05) in the testosterone levels. There was a significant decrease (p < 0.05) in triglyceride (TG) in HFDEL group compered to HFD group. The histological sections of aortas revealed a significant decrease (p < 0.05) in IMT in HFDEL as compared with HFD group. No histological changes were observed in NDEL group compared with ND group and there was no significant difference in IMT values between NDEL and ND. These findings suggest that EL is a promising protective agent against atherosclerosis induced by high-fat diet.

Reduced arterial compliance in patients with diabetes mellitus has been shown in several studies, but it has not been significantly associated with either atherosclerosis or vessel wall thickness. Blood pressure variability is still poorly explored in diabetic patients. The aim of this study was to compare blood pressure variability and arterial compliance in patients with type 2 diabetes mellitus and controls matched for sex, age, and weight. Arterial compliance was measured and noninvasive 24-h ambulatory blood pressure monitoring was performed in 18 diabetic patients and 18 controls. There was significantly higher 24-h systolic blood pressure variability (17.7 ± 6.8 vs. 14.6 ± 2.6mmHg), diastolic blood pressure variability (15.6 ± 7.1 vs. 11.4 ± 3.1mmHg), and mean arterial blood pressure variability (14.8 ± 7.0 vs. 11.1 ± 2.9) in diabetic patients. Systolic, diastolic, and mean arterial blood pressure variability was significantly higher during daytime but not night time in diabetic patients compared to controls. Diabetic patients also had significantly reduced small artery compliance, but no differences in large artery compliance, cardiac output, or systemic vascular resistance. The findings suggest that hyperglycemia may affect the compliance of the vascular system, resulting in high blood pressure fluctuations.

Introduction: Eurycoma longifolia (E. longifolia) which is better known locally as Tongkat Ali is an indigenous plant in Malaysia. It belongs to the family of Simaroubaceae and is popular as a traditional medicine for its aphrodisiac properties. Throughout the years, several studies have been conducted to prove its effect on aphrodisiac action, antimalarial, antibacterial and anxiolytic properties but its effect to the cardiovascular system had not been fully explored. This study was aimed to demonstrate the changes that take place in the isolated heart following the injection of the extract. Methods: Three parameters that were measured included the coronary perfusion pressure (CPP), the left ventricular developed pressure (LVDP) and the heart rate (HR). Eighteen isolated rat hearts were used and were divided equally into three groups. The first group was to observe the effect of Isoprenaline, a 6 agonist while the second group was to see the effect of sodium nitroprusside (SNP), a nitric oxide (NO) donor. The dose which gave the maximum effect for these two positive controls was used to compare with the effect of E. longifolia water extract in the third group of rats. Isolated heart was mounted using the Langendorff apparatus and perfused with modified Krebs-Henseleit buffer. Doses of controls and the extract were instilled through an injection port, and the effect of each dose was monitored. Results: E. longifolia extract was found to reduce the CPP in normotensive rat at two of the highest doses. A dose of 1.0 mg of the extract reduced the CPP significantly from 34.52 � 4.99 mmHg of the baseline value to 31.99 � 4.93 mmHg while the dose of 10.0 mg of the extract reduced the CPP significantly to 32.67 � 3.89 mmHg. However, there were no significant changes of effect of the extract on the LVDP and HR as compared to control. Conclusion: These early findings suggest that E. longifolia extract may have vasodilatory property, which supports its traditional usage with minimum cardiovascular side effects.

There is increased prevalence of hypertensives among Malaysians in the last decade. The cost of anti-hypertensive agents is also escalating. There is a dire need for cheaper alternative drugs. In tropical regions, there have been claims that Eurycoma longifolia (EL) a local herbal plant is effective in obliterating headache and reducing blood pressure. Most studies had focused on aphrodisiac property of EL which has been shown to enhance testosterone levels in males. This study exploredthe possible effect of EL as an anti-hypertensive agent and whether the mechanism is related to serum testosterone levels. Twenty four healthy male Sprague-Dawley rats were randomly divided into four groups (n=6): normal diet (ND), normal diet treated with EL (NDEL), high-fat diet (HFD) and HFD treated with EL (HFDEL). EL (15 mg/kg) was administered orally for 12 weeks. The animal's body weight, blood pressure and testosterone level were measured at week 0, 6 and 12.Results showed that the level of testosterone in groups receiving EL were significantly increased (P < 0.05) from the untreated groups, in agreement with previous studies report on EL increasing testosterone level. Rats with high fat diet benefitted from treatment with EL extract (HFDEL)as there were reduced systolic and diastolic blood pressure significantly (P < 0.05). Despite this effect, there were no significant correlations between blood pressure and testosterone level in HFDEL. There were no changes of blood pressure in rats receiving normal diet with or without EL, but there was a significant negative correlation (r= -0.846, p=0.034) between testosterone and diastolic blood pressure in NDEL. This study suggested the presence of anti-hypertensive property of EL in high fat diet induced hypertension, but it not associated with testosterone level. The blood pressure lowering mechanism through testosterone hormone however is only seen in normal diet group. � 2017 Rafidah Hanim Mokhtar et al.

Introduction. Male-to-female transgender individuals are known as mak nyahs in Malaysia. Akin to many other countries, mak nyahs face discriminations in securing proper employment, thus many end up in sex trade, exposing them to HIV-related high risk behaviours. This paper aims to investigate the knowledge, attitude, and risk behaviours in HIV/AIDS among mak nyahs in Malaysia. Method. Validated questionnaires in local language were used. Knowledge, attitude, and HIV-related risk behaviours were measured. With respondent-driven sampling method, 54 subjects participated in the survey. IBM SPSS was used for data analysis. Results. Majority of the subjects reported to have HIV-related sexual risk, although only a quarter were sex workers. Misconceptions still remained among the subjects. Inconsistent condom use was common. Adequate knowledge did result in better attitude towards HIV/AIDS. However, multiple regression analysis showed that subjects with higher knowledge in HIV/AIDS tend to have higher sexual risks (? = 0.320, p = 0.030). Conclusion. Educating the transgender community about HIV/AIDS does not seem to adequately reduce the HIV-related sexual risks. Other approaches, i.e. socio-cultural values and religious practices may be effective to instil higher levels of awareness and self-responsibility in this community to eliminate HIVrelated high risk behaviours. � 2018 Default.

Objective: The aims of this study were to investigate the adverse effects of the high-fat-diet (HFD) on the testosterone level and testicular structure of male rats as well as to examine whether Eurycoma Longifolia (EL) is able to ameliorate these effects. Methods: Twenty-four male Sprague-Dawley (SD) rats were divided into four groups each containing 6 rats. Group ND was given only normal diet, group NDEL was given normal diet and EL extracts (15 mg/ kg) dissolved in distilled water, group HFD was given only high-fat-diet and group HFDEL was given high-fat-diet and EL extracts (15 mg/kg). EL was administered orally for 12 weeks. The animal's testosterone level was measured at week 0, 6 and 12. The rats were sacrificed at the end of 12th weeks and the testes samples were processed for histological examination Results: The testosterone level was significantly increased (p < 0.05) in the in the treated rats with EL (NDEL and HFDEL) compared with ND and HFD groups. Treatment with HFD revealed a marked degeneration of the seminiferous tubule epithelium and disruption of interstitial cells of the testis thereby interfering with spermatogenesis. Treatment of HFD rats with El reduced the adverse effects of HFD and improved the morphological structure of the seminiferous tubules. Conclusion: These findings revealed that EL has ameliorative effects against the testicular damage caused by high-fat-diet.