Journal of Health and Translational Medicine (JUMMEC)
Dear authors, we regret to inform you that Jummec will be closing down at the end of December 2024 and will no longer be accepting new submissions. The Journal of Health and Translational Medicine (JUMMEC) was founded in 1996. When JUMMEC (abbreviated for "Journal of University of Malaya Medical Centre") was first conceived, it was only publishing research findings that had been conducted in University of Malaya Medical Centre. Over the next few years, this journal grew in function and rapidly became popular amongst the local universities. It was not long thereafter that this journal began to gain interest by the global research community. In 2012, it was decided that a change in the journal name had to be made in order to reflect the international participations to this journal. However, we have never deviated from our primary aim, which is to facilitate the exchange of ideas, techniques and information among all members of the medical health practitioners and scientists alike. Topics covered include: All aspect of medicine, medical systems and management; surgical and medicinal procedures; epidemiological studies; surgery and procedures (of all tissues); resuscitation; biomechanics; rehabilitation; basic science of local and systemic response related to the medical sciences; fundamental research of all types provided it is related to medical sciences; cell, proteins and gene related research; all branches of medicine which may include (but not limited to) anaesthesia, radiology, surgery, orthopaedics, ortholaryngiology etc. Regular features include: original research papers; review articles and case reports. Letters that comment on an article previously published in JUMMEC are particularly encouraged, and the authors will be given the opportunity to respond. Please submit letters to the editor by e-mail where possible to email: jummec@um.edu.my This journal offers TRUE OPEN ACCESS and FREE ONLINE PUBLISHING. Issues are published BIANNUALLY in June and December every year. Special issues will be in addition to the two (2) regular issues per year. Print ISSN:1823-7339 (1996-2010) E-ISSN:2289-392X (2011-2024) Publisher: Faculty of Medicine, Universiti Malaya Indexing: NOTE: As of September 2011, JUMMEC is published as an on-line journal only and produces non off-prints. This effort is part of our commitment to ensure that JUMMEC is readily available and can be accessible to the public freely, quickly and with little or no restrictions. This decision is also in line with our policy to help save the environment by reducing the number of papers used to produce printed articles.
All authors agree that the article, if editorially accepted for publication, shall be licensed under the Creative Commons Attribution License 4.0 to allow others to freely access, copy and use research provided the author is correctly attributed, unless otherwise stated. All articles are available online without charge or other barriers to access. However, anyone wishing to reproduce large quantities of an article (250+) should inform the publisher. Any opinion expressed in the articles are those of the authors and do not reflect that of the University of Malaya, 50603 Kuala Lumpur, Malaysia.
2024: International Conference of Human Performance and Health (ICHPH) 2023
SPORTS, MILITARY AND ANTI-DOPING (ICHPH2023)
Copyright (c) 2024 Journal of Health and Translational Medicine (JUMMEC)
UNRAVELLING TUBERCULOSIS PERCEPTIONS: A QUALITATIVE STUDY IN HIGH TUBERCULOSIS ENDEMIC COMMUNITIES IN NORTHERN SABAH
Tuberculosis (TB) remains a major public health concern globally. A wider conceptual comprehension of people’s health beliefs and concerns about TB can contribute to achieving the aimed reduction in disease burden, through informed interventions tailored according to the local context. This study explores the notion of TB among community members in high TB endemic localities in Northern Sabah, Malaysia. Grounded-theory study design was utilized to gather data from 42 individuals through in-depth interviews using semi-structured questions, selected purposively by age. Individual interviews were audiotaped, transcribed, and translated into English. The data was analysed using thematic analysis. A majority of the respondents have heard of TB, but do not know what TB is. Most participants agreed that TB is a serious disease that could be fatal, and are worried about getting TB, but showed apprehension about the risk of getting the disease. Their knowledge and risk perception towards TB may affect their response to seeking diagnosis through disease screening. This study revealed persistent misconceptions about TB, which could potentially impact people’s willingness to undergo disease screening and seek appropriate treatment. Promoting health education on TB through a tailored approach according to the local context is crucial.
Copyright (c) 2025 Journal of Health and Translational Medicine (JUMMEC)
EMPATHY, PROFESSIONAL VALUE AND PROFESSIONAL QUALITIES OF LIFE AMONG NURSING STUDENTS AT A PUBLIC UNIVERSITY IN SELANGOR
Work stress and burnout are common among healthcare workers, including nursing students, due to heavy workloads and long-term exposure to patient care. Adaptation of empathy and professional values can affect the quality of life among nursing students. This study aimed to determine the relationship between empathy, nursing professional value, and professional quality of life (ProQOL) among nursing students at a public university in Selangor. A cross-sectional study was done using purposive sampling, and 128 nursing students from UiTM Puncak Alam were recruited to participate in this study. Students completed a self-report online questionnaire that included the Jefferson Scale of Empathy, the Nursing Professional Values Scale, and the Professional Quality of Life Scale. The finding shows that students reported a higher level of nursing professional value, an average level of empathy, and a medium level of ProQOL. A fair, positive correlation exists between empathy and nursing professional value (r = 0.309, p < 0.01). Empathy and professional values are essential for fostering resilience and reducing burnout among nursing students in clinical settings. Self-awareness and a firm grasp of these values help mitigate compassion fatigue and negative workplace patterns, promoting emotional well-being and high-quality care.
DETERMINING THE IMPACT OF WORK-LIFE BALANCE AND JOB SATISFACTION ON NURSES' PERFORMANCE IN TEACHING HOSPITALS: A CROSS-SECTIONAL STUDY
Nursing is a noble profession that involves caring for disabled patients. The demanding nature of nursing work has an impact on their work-life balance (WLB). Workplace stress also negatively affects work-life balance, job satisfaction, and performance. This research aims to determine the impacts of work-life balance and job satisfaction on nurses’ performance in a teaching hospital. This cross-sectional survey, employing purposive sampling, involved 205 registered nurses across diverse departments at Hospital Sultan Abdul Aziz Shah (HSAAS), UPM. This study utilized the Work-life Balance Scale, Job Satisfaction Scale, and Job Performance Scale as research instruments to measure work-life balance, job satisfaction, and job performance among nurses. The finding revealed a moderate to high level of WLB among nurses in teaching hospitals (M = 54.39, SD = 9.439). The relationship between work-life balance and the performance of nurses was reported to be significant (p < 0.000). There is a positive correlation between job satisfaction and job performance in nursing (p < 0.001, r = 0.574). Additionally, the research revealed a significant association between nurses’ work hours and their degree of work-life balance (p = 0.01). In addition, nurses’ service duration was also associated with their work-life balance (p < 0.001). The findings indicate that WLB and job satisfaction significantly influence nurses’ performance. The findings also emphasize the necessity of work-life balance and job satisfaction strategies to achieve high performance in nursing.
TUBERCULOSIS OF THE RIB WITH COLD ABSCESS MIMICKING BENIGN BONE LESION
Tuberculous osteomyelitis of the ribs represents a rare extrapulmonary manifestation of tuberculosis (TB), often posing significant diagnostic challenges due to its resemblance to benign lesions. The case of a 1-year-old boy with a swelling on the left anterior chest wall initially misdiagnosed as sebaceous cyst is presented. The significant growth of the swelling prompted further evaluation to rule out Ewing sarcoma. Clinical examination and imaging revealed multiseptated abscess with left fifth rib lytic lesion. Empirical anti-TB treatment was initiated based on clinical suspicion, which was subsequently confirmed by mycobacterium TB PCR despite a negative mycobacterium culture. The patient showed clinical and radiological improvement following anti-TB therapy. This case underscores the importance of considering TB osteomyelitis in the differential diagnosis of paediatric rib lesions, especially in TB-endemic regions, and highlights the role of prompt diagnostic imaging and empirical treatment to ensure timely management and effective disease containment.
2024: Malaysian Congress of Radiology (MCOR 2024)
We stand at the crossroads of medical progress, where the intricate tapestry of tradition intertwines seamlessly with the boundless realms of innovation. The Malaysian Congress of Radiology 2024, held from 26-28th July 2024 in the vibrant city of Kuala Lumpur, serves as a beacon for the convergence of foundational knowledge and cutting-edge advancements in the field of radiology. Within the pages of this abstract book, we present the culmination of intellectual pursuit and scientific rigor, showcasing the abstracts carefully curated from a pool of brilliant minds. The theme of "Beyond The Report: Interplay of Language and Radiology" encapsulates the essence of this congress, as radiologists, radiology trainees, and allied health professionals come together to explore the harmonious interplay between timehonoured practices and pioneering technologies. I commend the dedication and expertise of all those who have contributed to this abstract book. May it inspire fruitful discussions, ignite fresh insights, and foster collaborations that will shape the future of radiology, ensuring the highest standards of patient care and medical excellence.
UNCOMMON PRESENTATION OF A LONG-STANDING CALCIFYING FIBROBLASTIC GRANULOMA IN THE POSTERIOR MANDIBLE
A 14-year-old Malay female was referred in view of a five-year history of an enlarging swelling over her lower right teeth, causing a disturbance in eating, speaking, and reciting Quranic verses. Clinical examinations revealed a non-tender, pedunculated exophytic growth on the buccal site measuring approximately 1.3 cm x 1.5 cm and the lingual site approximately 2.9 cm x 2.5 cm in size. The lesion encompassed her right mandibular first molar and second premolars with pinkish-red overlying mucosa and ulcerations on the lingual and occlusal aspects of the swelling. The right mandibular first molar had grade I mobility and 5 mm periodontal pocket depth associated with grade I furcation involvement. Deep scaling was performed on the involved area, and the excisional biopsy was performed under general anaesthesia. Histopathological examination revealed cellular connective tissue with focal calcifications, which gave a final diagnosis of Calcifying Fibroblastic Granuloma (CFG). The patient had an evaluation for oral hygiene maintenance and phase I periodontal treatment, which included deep scaling and a prescription for chlorhexidine mouthwash. No recurrence was observed one year post-operatively.
ANTIBIOTICS FOR PAEDIATRIC PATIENTS IN DENTISTRY: AN OVERVIEW OF AVAILABLE GUIDELINES
The administration of antibiotics in children undergoing dental procedures is generally contemplated in specific instances to prevent or address potential infections. This thorough review aims to enhance current guidelines by integrating additional evidence regarding the need for administering antibiotics to children undergoing dental treatments. We conducted an extensive review of literature, focusing solely on English-language sources retrieved from SCOPUS, MEDLINE, and PubMed databases up to August 2023. Our primary focus was on exploring the utilisation of antibiotics in paediatric dental care. Inaccurate antibiotic prescriptions can result in widespread consequences, such as the development of bacterial resistance, complications in the gastrointestinal and haematological systems, and disruptions in the bacterial microbiota. This review highlights the importance of following existing guidelines for prescribing antibiotics in paediatric dental care, underscoring the crucial role of dentists' clinical judgement before authorising prescriptions. Additionally, it strongly promotes collaborative communication with medical practitioners to evaluate the patient's clinical condition. Consequently, it is imperative to establish comprehensive antibiotic prescribing guidelines for dental professionals.
ORAL HEALTH IMPACT AMONG PERIODONTAL PATIENTS AT SUPPORTIVE PERIODONTAL CARE: A CROSS-SECTIONAL STUDY
Periodontitis is a chronic inflammatory disease that affects the supporting structures of the teeth, leading to progressive attachment loss and bone destruction. It significantly impacts the quality of life of affected individuals. Despite this, there is a lack of research focused on patients in supportive periodontal care (SPC) within periodontal treatment. This study aimed to determine the impact of periodontitis and other possible factors on oral health-related quality of life (OHRQoL) among patients in SPC using the Malaysian version of the Oral Health Impact Profile (OHIP-14). This study included 219 individuals diagnosed with periodontal disease who had completed active periodontal treatment and were now on regular maintenance. All participants completed the OHIP-14 questionnaire, along with socioeconomic and demographic surveys. A calibrated clinician conducted clinical periodontal examinations to evaluate the patients’ current periodontal conditions. The findings indicate that periodontal diseases significantly affect OHRQoL. The OHIP-14 scores were linked to variables such as age, race, educational background, household income, overall health, duration of SPC, and satisfaction levels regarding general oral and periodontal health. The highest OHIP-14 domain scores were for psychological discomfort, followed by functional limitation and physical disability. Discomfort due to food being stuck had the highest mean score of 2.27 ± 1.11, while avoidance of socializing had the lowest mean score of 0.48 ± 0.83. Multiple linear regression analyses highlighted that being Malay, medically healthy, and having a higher education level had a more pronounced impact on OHRQoL. These findings underscore the significant negative impact of periodontitis complications on OHRQoL during SPC, with race, medical status, and education level being critical influencing factors.
UNEXPLAINED NEUROLOGICAL DEFICIT WITH IMPAIRED VASCULAR PERFUSION: A MISSED TELL-TALE SIGN OF AORTIC DISSECTION PRESENTING IN A DISTRICT HOSPITAL
Acute aortic dissection can present with a diverse range of clinical signs and symptoms. It is a condition with high morbidity and mortality that could be missed without a high index of suspicion. This case examines a 45-year-old gentleman who presented to a district hospital with hemodynamically unstable, acute right-sided body weakness associated with a fall the day prior. He also reported frank haematuria, with suprapubic, pelvic, and right thigh pain for the past three days. A preliminary diagnosis of cerebral vascular accident with a need to rule out intracranial bleeding was made, and he was arranged for an urgent computed tomography brain scan at a secondary hospital. Unfortunately, he eventually succumbed to cardiac tamponade secondary to aortic dissection. This case highlights the challenge clinicians face in identifying a vascular emergency that disguises with a history of trauma. This challenge is further amplified in hospital settings with scarce resources and expertise. Therefore, a thorough history taking, a focused physical examination, and a high index of suspicion are crucial for making an accurate diagnosis.
A CASE REPORT ON PRIMARY RENAL LYMPHOMA - A DIAGNOSTIC DILEMMA
Primary Renal Lymphoma (PRL) is diagnosed when lymphoma affects the kidneys and there is no evidence of lymphatic manifestation outside the kidneys. PRL is very rare, with an incidence of less than 1%. This case report highlights Computed Tomography (CT) features of PRL in a 68-year-old female with histology-confirmed renal lymphoma. She presented with worsening left flank pain for two months, associated with constitutional symptoms. Abdominal examination reveals a tender mass in the left hypochondriac region, extending to the left lumbar region. Ultrasound revealed an irregular, solid hypoechoic lesion with cystic spaces in the left kidney. Multiphasic CT renal revealed a large ill-defined mass with poor enhancement in both corticomedullary and nephrographic phases, with no significant washout in the delayed phase. It has a low attenuation value of +30 to +50HU on non-enhanced CT and contains no calcification. Meanwhile, in other renal malignancies, particularly Renal Cell Carcinoma (RCC), a renal mass will exhibit significant enhancement with contrast washout in the delayed phase. RCC often demonstrates early infiltration into the Inferior Vena Cava (IVC). The patient is treated with chemotherapy, and a follow-up Positron Emission Tomography-Computed Tomography (PET-CT) presents a smaller left renal mass. In conclusion, a hypovascular renal mass on CT should raise the suspicion of a PRL, and early tissue diagnosis is important to avoid unnecessary nephrectomy.
LIGNOCAINE INFUSION FOR NEUROPATHIC ITCH IN PATIENT WITH NEUROFIBROMATOSIS
Neurofibromatosis (NF) is an autosomal dominant neurocutaneous disorder. The itchiness suffered by patients with NF is possibly caused by mast cells. However, transient receptor potential ankyrin 1 (TrpA1) and transient receptor potential vanilloid 1 (TrpV1) have been recently discovered as mediators of itchiness and pain in patients with NF. We reported a patient with NF, afflicted by neuropathic pain and itch, despite despite receiving conservative treatment. Herein, we provided the patient lignocaine infusion, which improved her pain and itch score by 50%. Additionally, her sleep quality, ability to perform housework and engagement in leisure activities were improved. This case report highlights the therapeutic value of lignocaine infusion when conservative treatment is ineffective for chronic neuropathic itch in patients with neurofibromatosis through suppressing TrpA1 and TrpV1.
A RARE CASE OF ACUTE MOTOR AXONAL NEUROPATHY IN A ONE-YEAR-OLD MALE CHILD
Acute Motor Axonal Neuropathy (AMAN), a major subtype of Guillain Barre’s Syndrome (GBS), is a rare non-inflammatory disease where the axons of motor neurons are selectively targeted by the immune system. This report describes the case of a one-year-old male suffering from this rare condition. The patient presented with complaints of bilateral lower and upper limb weakness, accompanied by fever. Clinical and electromyographic investigations confirmed the diagnosis as AMAN. Treatment included intravenous immunoglobulin (IVIg), antibiotics, multivitamins, zinc, and physiotherapy, which led to significant improvement in the patient’s condition. Early diagnosis, along with prompt initiation of IVIg and physiotherapy, may greatly enhance recovery from GBS-AMAN in pediatric patients.
COMPARATIVE ANALYSIS OF PROSTATE VOLUME MEASUREMENT USING TRANSABDOMINAL ULTRASOUND, TRANSRECTAL ULTRASOUND, AND MRI: A RETROSPECTIVE OBSERVATIONAL STUDY
Introduction: Prostate volume (PV) measurement is crucial for managing prostate conditions, including benign prostatic hyperplasia (BPH). Its range can be measured using different imaging modalities like transabdominal ultrasound (TAUS), transrectal ultrasound (TRUS), and magnetic resonance imaging (MRI) of the prostate, which were compared in this study. Methods: A single tertiary centre retrospective observational analysis was conducted on PV measurements obtained through TAUS, TRUS, and MRI prostate from the same patients prior to biopsy. The mean of PV from each imaging modality was analysed using the Analysis of Variance (ANOVA) and a Tukey post hoc test, with p < 0.05 was considered statistically significant. Results: Only 311 out of 718 patients who underwent TRUS biopsy from January 2018 until December 2022 were eligible for this study based on the inclusion criteria. The median age and PSA were 71 years old and 7.5 ng/mL, respectively. No significant difference was found across the means of the imaging modality and PV measurement among the imaging modalities (F = 0.713, p = 0.49). The Tukey post hoc test also revealed no significant difference between each modality, namely TAUS-TRUS (p = 0.45), MRI-TRUS (p = 0.79), and TAUS-MRI (p = 0.85). Conclusion: This study demonstrated no statistically significant relationship in prostate volume measurements from the three different imaging modalities, namely TAUS, TRUS, and MRI.
ADDUCTOR CANAL AND SUPERIOR LATERAL GENICULAR NERVE INJECTIONS FOR GRADE 4 KNEE OSTEOARTHRITIS: A CASE REPORT
This case report showcases the successful use of a combination of adductor canal (AC) and superior lateral genicular nerve (SLGN) injections in a patient with refractory knee pain caused by knee osteoarthritis (OA). A 73-year-old man with Kellgren and Lawrence (KL) Grade 3-4 of bilateral knee OA experienced debilitating chronic right knee pain and declined surgery intervention. He reported significant pain relief, which improved his ability to walk, after receiving a combination of AC and SLGN injections with a mixture of local anesthetic and steroids. This followed the unsuccessful provision of multiple analgesics and intraarticular injections. The pain-relieving effects persisted until his 2-month follow-up. Repeated injections were performed 4 months after his initial intervention, with the analgesic effect lasting for another 2 months. This case report suggests that the combination of AC and SLGN injections could be a viable treatment for patients with knee OA KL Grade 4 who are not candidates for surgery.
DIAGNOSING OVARIAN TORSION IN THE EMERGENCY DEPARTMENT: A CASE REPORT AND LITERATURE REVIEW
Diagnosing acute abdomen in emergency department setting, especially in women of childbearing age, is challenging. The patient may present with non-specific complaints. We were presented with a case of a 28-year-old lady with no known medical illness complaining of sudden onset left-sided abdominal pain. Multiple analgesics were given, but her pain persisted. Bedside ultrasonography was performed and noted a multiloculated cyst over the left ovary, with the largest measuring 4 x 4 cm. She then underwent laparoscopic left salpingo-oophorectomy, revealing an engorged, gangrenous left fallopian tube and the left ovarian cyst was twisted three times. Histopathological examination confirmed a left ovarian haemorrhagic twisted ovarian cyst with a paratubal cyst. This case concludes that acute abdominal pain in women of childbearing age requires prompt and thorough investigation. Clinicians should consider several potential diagnoses, including ovarian torsion.
A CONCEPTUAL MODEL OF FRAILTY IN OLDER ADULTS: A LITERATURE REVIEW
This review employed several key procedures to synthesize the current evidence on frailty. An extensive literature search was conducted across major databases to identify relevant studies on frailty definitions, epidemiology, assessment tools, interventions, and conceptual models. The search results were analyzed using bibliometric techniques including thematic mapping with Biblioshiny and co-occurrence network visualization with VOSviewer. These bibliometric analyses identified core research themes, emerging topic clusters, and connections across the frailty literature. The main findings highlighted frailty's multidimensional nature spanning physical, cognitive, psychological, and social domains. While the frailty phenotype by Fried et al. (2) provided an initial operational definition, subsequent models increasingly encompassed a broader biopsychosocial frailty construct. Globally, over 10% of community-dwelling older adults were estimated as frail, with rates exceeding 40% in those over 90 years old. Frailty was associated with numerous adverse outcomes like disability, falls, hospitalization and mortality. Current assessment approaches included the frailty phenotype, frailty index, and various clinical performance tests, though no single comprehensive tool existed. Evidence supported tailoring multimodal interventions combining physical, nutritional, cognitive, psychological and social strategies to individual risk profiles. The principal conclusion was the critical need for a unified, holistic conceptual model elucidating the complex interplay of factors driving frailty's development and progression. Integrating the findings, a biopsychosocial framework was proposed conceptualizing frailty as a multifactorial health state arising from the cumulative impact of interconnected physical, cognitive, psychological, social and environmental determinants over the life course. Such models are essential for advancing frailty science, shaping clinical practices, and informing policies to promote healthy, resilient aging amid rapidly aging populations worldwide.
POSTPARTUM PITUITARY APOPLEXY: A CASE REPORT
Background: Postpartum pituitary apoplexy is an extremely rare neurological emergency. It may present with sudden onset of headache, vomiting, nausea and visual disturbances. This potentially life-threatening emergency requires a high index of suspicion from the attending clinician. Postpartum pituitary apoplexy was challenging to diagnose because of its symptoms that overlapped with multiple conditions. There are limited number of case reports on postpartum pituitary apoplexy. Case presentation: We present a case of a 30-year-old multipara with gestational diabetes mellitus presented with on and off headache since 37 weeks period of gestation. Her complaint was not investigated by medical personnel during her routine antenatal follow-up until she had a normal delivery. Subsequently, she developed diplopia, nauseated and vomiting episodes post-delivery but she only came to seek treatment in our emergency department on day 12 post-partum as symptoms are not resolving. Initial Contrast Enhanced Computed Tomography (CECT) of Brain revealed enhancing sellar lesion causing widening of pituitary fossa which then she was scheduled for Magnetic Resonance Imaging (MRI). MRI brain revealed lobulated sellar and suprasellar mass with mass effect to optic chiasm and she underwent endoscopic endonasal transsphenoidal excision of tumour. Post operatively, her vision improved and she was discharged subsequently with oral hormonal supplements. Conclusion: Diagnosis of pituitary apoplexy should be suspected whenever headache and neurological deficits are present although it is an extreme rare condition.
EFFECTIVENESS OF DIABETES SELF-MANAGEMENT EDUCATION (DSME) AND FAMILY-BASED INTERVENTIONS ON QUALITY OF LIFE IN PEOPLE WITH TYPE 2 DIABETES
Diabetes is a health condition that can have a significant impact on quality of life. Therefore, self-care management and family support may be important in helping people with diabetes maintain or improve their quality of life. The purpose of this study was to evaluate the effectiveness of the Diabetes Self-Management Education (DSME) program and family-based interventions in improving the quality of life of people with type 2 diabetes. This research was conducted using a quasi-experimental design with a one-group pre- and post-test. A sample of 54 individuals was selected using purposive sampling technique. Analysis was performed using dependent and independent t-tests. The results indicated that the DSME program was effective in improving quality of life in all domains (p < 0.05). Family-based interventions were shown to improve quality of life (p = 0.045) and psychological (p = 0.010) and environmental (p = 0.029) domains. However, the two interventions did not appear to differ in improving quality of life (ppre = 0.727; ppost = 0.466). The study concluded that DSME and family-based interventions are effective in improving quality of life in people with type 2 diabetes. These interventions can be implemented in other health care settings.
INNOVATIVE NANOPARTICLE DELIVERY OF TEA POLYPHENOLS FOR ENHANCED COLORECTAL CANCER THERAPY
Tea polyphenols have demonstrated potential in the prevention and treatment of colorectal cancer. However, its use in clinical settings has been hampered by drawbacks in terms of stability and bioavailability. This review aims to explore and evaluate the potential of nanoparticles as efficient delivery vehicles for tea polyphenols in the context of colorectal cancer therapy. In this review, we summarize studies on the efficacy of tea polyphenols on colorectal cancer and their limitations for colorectal cancer therapy. Moreover, we also discuss the mechanistic signalling pathway of tea polyphenols and how nanotechnology improves the limitations. Furthermore, the mechanisms performed using nanoparticles in drug delivery and the significance of nanoparticles for targeted drug delivery were covered in this review. The future of colorectal cancer therapy may be significantly influenced by the integration of nanotechnology to deliver tea polyphenols. Nanoparticle-based delivery systems promise to overcome inherent challenges associated with the bioavailability and targeted delivery of tea polyphenols. By enhancing solubility, stability, and controlled release, nanotechnology can optimise the therapeutic efficacy of these bioactive compounds.
THE USE OF HYPNOSIS AS AN ADJUNCT TO NITROUS OXIDE/OXYGEN SEDATION: A CASE SERIES
It is known that managing patients with dental fear and anxiety is challenging for clinicians and patients. This series of case reports highlights the importance and benefits of dental management under clinical hypnosis as an adjunct to nitrous oxide inhalation sedation for ages six to fifteen. These treatments range from pulp therapy, extraction and minor oral surgery. Customised hypnosis scripts were utilised for each patient, and the metaphors used were tailored to the patient’s interest and preference. The intended treatment was successfully carried out in all the patients. Five cases discussed in this case series were initially indicated for treatment under general anaesthesia, but treatment was successfully carried out using hypnosis and nitrous oxide/oxygen sedation. In the two surgical cases, nitrous oxide was tapered off once local anaesthesia was achieved, and the state of relaxation was maintained using a hypnotic trance, reducing the anaesthetic agent’s utilisation. Hypnosis successfully reduces patients’ anxiety, allowing them to feel more relaxed and confident about accepting future dental treatment without the need for pharmacological intervention.
THE EFFECT OF ETHANOLIC EXTRACTS FROM VARIOUS TYPES OF BETEL LEAVES ON THE GROWTH OF PORPHYROMONAS GINGIVALIS
People in Southeast Asia have widely used betel leaves for traditional daily medicine. Several types of betel leaves have been empirically proven to treat various dental and oral diseases. Four of them are black betel (Piper betle var. Nigra), green betel (Piper betle L.), earth betel (Peperomia pellucida) and red betel (Piper crocatum). This research aimed to compare the effect of the four types of betel leaf extract inhibiting the growth of Porphyromonas gingivalis (P. gingivalis), the periodontal pathogenic bacteria. The design of this study was a post-test control group design using in vitro disc diffusion method. There were 4 test groups, namely the black betel, green betel, earth betel, and red betel groups, each consisting of a concentration of 25%, 50%, 75%, and 100%. Sterile distilled water was used as the negative control, while the positive control is Metronidazole gel 25%. Sixteen repetitions were performed for each group, and then the average diameter of the inhibition zone formed in each group was calculated using a caliper. The results showed that all groups were effective in inhibiting the growth of P. gingivalis bacteria, with the highest effectiveness obtained from 100% concentration, sequentially 19.65(±0.64) mm for black betel, 19.85(±0.61) mm for green betel, 21.70(±0.53) mm for earth betel, and 25.16(±1.00) mm for red betel. Even so, these results are still below the effectiveness of metronidazole, producing an inhibition zone of 27.50(±0.09) mm. There is a significant difference in the comparison between concentrations for each type of betel leaf (P-value < 0.05). Likewise, comparing each concentration between each kind of betel leaf, the result is also a significant difference (P-value: 0.000). These results prove that betel leaf has efficacy as an antibacterial agent, which might be due to the presents of flavonoids, alkaloids, tannins, and essential oils.
POTENTIAL OF CHITOSAN BLACK SOLDIER FLIES (Hermetia Illucens) PUPAE ON POST-EXTRACTION WOUND HEALING PROCESS
Chitosan can accelerate the wound healing process by increasing inflammatory cells, such as macrophages, and increases fibroblast proliferation after tooth extraction. The Black Soldier Fly (BSF) pupae containing 35% chitin, which can be processed into chitosan and was found to have potential benefits in post-extraction wound healing. This study aimed to assess the potential of chitosan BSF pupae by monitoring the presence of macrophages and fibroblasts after tooth extraction. Chitosan BSF pupae was made into a gel preparation. Eighteen male Cavia cobaya were divided into control and treatment groups (n = 9 each). BSF pupae chitosan gel was applied to the post-extraction tooth socket in the treatment group (CBSF), while none was applied to the control group (CC). The samples were decapitated on the 2nd, 3rd, and 5th days by cutting the mandibular bone for histopathological examination, which was carried out by measuring the number of macrophages and fibroblasts through microscopic observation and data analysis. There an increase in macrophages evident in CBSF group than in CC group on the 2nd and 3rd days, while a decrease was seen on the 5th day of CBSF group than CC group. There was an increase in fibroblasts evident in CBSF group than in CC group on the 2nd, 3rd, and 5th days. Kruskal Wallis test indicated a significant difference in macrophages between the control and the treatment group (p = 0.006), and the One-way ANOVA test showed a significant difference in fibroblasts between both groups (p = 0.000). In conclusion, the application of chitosan BSF pupae accelerated the post-extraction wound healing process in Cavia cobaya by modulating the number of macrophages and increasing the number of fibroblasts.
FRACTURE TOUGHNESS AND FRACTURE MODE OF CEMENT-RETAINED VERSUS SCREW-RETRIEVABLE CEMENT-RETAINED IMPLANT-SUPPORTED CROWNS: A PILOT STUDY
The aim of this pilot study was to compare the fracture toughness and fracture mode of cement-retained versus screw-retrievable cement-retained implant-supported monolithic zirconia crowns. Ten implant-supported crowns were made from monolithic CAD/CAM zirconia and equally divided into control and test groups. The control group received cement-retained monolithic zirconia crowns (CR), while the test group received screw-retrievable cement-retained monolithic zirconia crowns (SRCR). The crowns were then bonded to prefabricated Variobase titanium-based abutments with resin luting cement. To simulate the aging process in the oral cavity, all samples were undergone thermal cycling machine. After ageing, each group underwent a single load fracture test to analyze the fracture load, and the fracture mode was evaluated using scanning electron microscopy (SEM). The Mann-Whitney U test was used to compare fracture toughness, and statistical significance was set at p<0.05. The mean fracture toughness of CR crowns was 2945.49 ± 511.426 N, while that of SRCR crowns was 2897.82 ± 510.837 N, but the difference was not significant (U=10, p= 0.917). SEM examination revealed that all failures originated from the fitting surface of the crowns. The titanium-based abutment remained intact in all specimens. Within the limitations of this pilot study, the CR showed higher fracture toughness than SRCR implant crown, but both specimen fracture at six times more than the average maximum bite force of posterior tooth. The presence of screw access in SRCR has affected the fracture mode.
EFFECT OF A LOCALLY MANUFACTURED TOOTHBRUSHING SIMULATOR ON THE MONOMER ELUTION OF CAD/CAM RESIN COMPOSITE BLOCK - A PILOT STUDY
Objective: This pilot study aimed to calibrate the high-performance liquid chromatography (HPLC) protocol for detection and quantification of monomer that may be eluted from a computer-aided design and computer-aided manufacturing (CAD/CAM) resin composite block (RCB) when subjected to an abrasion test with a toothbrushing simulator. Materials and methods: CAD/CAM RCB (Shofu Block HC) were sectioned and randomly allocated into two groups made up of Control group (CT) group (n = 4), and Toothbrush Abrasion (TA) group (n = 4). CT group was subjected to no surface treatment and TA group was subjected to a toothbrushing wear test following immersion of both groups in artificial saliva for 7 days. High Performance Liquid Chromatography (HPLC) was used to separate and identify urethane dimethacrylate (UDMA) and triethylene glycol dimethacrylate (TEGDMA) that were eluted from the slurry produced following the toothbrushing abrasion test of the TA group and from storage solution of artificial saliva of the CT group. Results: After the toothbrush wear test, 6.192 to 16.937 ng/µL of UDMA eluted from the TA group and no UDMA was detected in the CT group. TEGDMA was not detected from both the CT and TA groups. Conclusion and clinical significance: The HPLC protocol has been calibrated and toothbrushing wear resulted in detectable UDMA released from Shofu HC Block at a level that is not harmful to the patient.
THE COMPARISON OF SUMATERA FOREST HONEY AND TRIAMCINOLONE ACETONIDE FOR TRAUMATIC ULCER HEALING IN WISTAR RAT: CLINICAL AND HISTOLOGICAL EVALUATION
Traumatic ulcer is ulcerated lesion on oral mucosa commonly caused by mechanical injury. The clinical picture of a traumatic ulcer is a solitary ulcer, it can be oval or irregular in shape, the center of the ulcer is yellow-gray or white/grey with erythematous edges. Traumatic ulcer cause difficulty in mastication, speech, and swallowing. Forest honey is a traditional medicine that can be used to heal traumatic wounds because of its anti-inflammatory, antimicrobial, antioxidant, and covering agent. The purpose of this study was to determine the effectiveness of Sumatera Forest honey on healing of traumatic ulcer in Wistar rats. This study is a quasi-experimental study. This study involved 32 rats divided into two groups, each containing 16 rats, namely the treatment group (100% forest honey) and the control group (Triamcinolone Acetonide). The animal model was slashed with a scalpel to induce an ulcer. The data collection was done by examining the size of the ulcer and erythema and then observed on the 1, 5, 7, 10 and 14 days. Analysis in this study used the Mann Whitney and Cochran statistical test. The results showed that Sumatera-forest honey significantly reduce ulcer size (p = 0.001) and erythema (p = 0.000). Sumatera forest honey is effective in healing traumatic ulcer.
THE INFLUENCE OF DENTAL BLEACHING TECHNIQUES ON MICROLEAKAGE OF COMPOSITE RESIN RESTORATION: A SYSTEMATIC REVIEW
Dental bleaching is a popular and conservative aesthetic technique used to whiten discolored teeth. However, there are concerns about the adverse effects of bleaching on composite restorations, such as color change, decreased bond strength, and microleakage. This review aims to evaluate the influence of tooth bleaching on composite restoration microleakage and to investigate the suggested methods used to prevent microleakage in composite restorations. A comprehensive search was conducted using four databases - PubMed, Scopus, Web of Science, and EBSCOhost - using a list of core keywords that included: ((Bleaching OR Whitening) AND ("dental adhesives" OR bonding OR "total-etch" OR "Self-etch" OR "total etch" OR "Self etch”) AND (Dental OR Enamel OR Dentin)). The inclusion criteria were in-vitro experiments written in English that involved composite restoration microleakage as the primary outcome due to bleaching. Of 1524 articles from the initial search, 18 were eligible for this review. Among the two major groups included in the study, the post-restorative bleaching group demonstrates highly varied results on the occurrence of microleakage. Conversely, the pre-restorative bleaching group indicates that bleaching materials can adversely affect the marginal integrity of the composite restoration. It was suggested that the resulting microleakage can cause problems such as recurrent caries and postoperative hypersensitivity and may be due to the natural bleaching mechanism depending on the oxidation reaction to remove the stains on the tooth surface. This releases oxygen and free radicals, and the residual oxygen on the tooth surface may inhibit the resin polymerization and lead to microleakage but can be overcome by the help of antioxidant materials, such as sodium ascorbate. This review provides substantial evidence from the literature on the preventive mechanism of composite microleakage and precautionary techniques when bleaching on composite restorations.
CYTOTOXICITY AND CHARACTERISATION OF POLYMETHYL METHACRYLATE DENTURE BASE ENHANCED WITH LINSEED OIL (PMMA-L)
Objectives: Polymethyl methacrylate (PMMA) is a widely used polymer for a denture base material. Dibutyl phthalate was previously utilised as a synthetic plasticiser in PMMA, but concerns about ester leaching have raised awareness of using organic plasticisers, such as linseed oil. The objective of this research was to assess the cytotoxic effects of linseed oil and to characterise the experimental polymethyl methacrylate enhanced with linseed oil (PMMA-L). Method: The cytotoxicity of linseed oil (LO) was evaluated by exposing Human Gingival Fibroblast (HGF) cells to different linseed oil concentrations (1%, 3%, 5%, 7%, and 10%) for 24, 48, and 72 hours. Afterwards, cell viability was measured with the WST-1 assay, and a spectrophotometer was used for cell quantification. Five groups of PMMA-L were prepared, each containing different percentages of linseed oil (1%, 3%, 5%, 7%, and 10% by weight). These samples underwent an ageing process involving 5,000 cycles of thermocycling between 5°C and 55°C with a 30-second dwell time. Compositional and leaching analyses of PMMA-L were performed using attenuated total reflection fourier-transform infrared spectroscopy (ATR-FTIR). Results: The results from the WST-1 assay consistently showed cell viability exceeding 95% across all doses and incubation periods, indicating the non-cytotoxicity of LO. Composition analysis revealed that the ATR-FTIR spectra of PMMA-L and linseed oil were identical within the C=C stretching vibration range (1536-1652 cm-1), originating from unsaturated triglyceride compounds found in linseed oil but not in PMMA. Additionally, the leaching analysis did not detect any leaching of linseed oil from PMMA-L. Conclusions: The research offers proof of the non-cytotoxic nature of linseed oil. Moreover, the successful creation of PMMA-L is evident, as indicated by the incorporation of the linseed oil component in PMMA-L and the absence of linseed oil in the leaching analysis.
PSYCHOSOCIAL IMPACT OF MALOCCLUSION ON ADOLESCENT PATIENTS IN KLINIK PERGIGIAN LANANG, SIBU, SARAWAK
Malocclusion affects dental aesthetics and a person’s psychosocial well-being. Patient’s perspective should be considered while assessing orthodontic treatment need. The objectives of this research were to study the psychosocial impact of dental aesthetics on adolescent patients attending Klinik Pergigian Lanang, and to determine its relationship with self-perceived need of orthodontic treatment, gender, age and race. A cross-sectional study was carried out on 167 adolescents aged 12-17 years visiting Klinik Pergigian Lanang using a self-administered questionnaire. All subjects answered all three sections of the questionnaire that included: demographic information (gender, age, race), Psychosocial Impact of Dental Aesthetics Questionnaire (Malaysian version), and the last section where they self-evaluated their own malocclusion using the Index of Orthodontic Treatment Need – Aesthetic Component. Prevalence and extent of psychosocial impacts were compared with self-perceived malocclusion status using Chi-Square and Fisher’s Exact Test. Severity of impacts was compared using Independent t-Test. Mean scores between age groups and gender were compared using Independent t-Test, whereas ANOVA was used to compare mean scores between races. The overall prevalence of impacts was 95.2% (n=159). Prevalence was highest in Dental Self-Confidence domain, followed by Psychological Impact, Social Impact and Aesthetic Concern. The prevalence in Dental Self-Confidence, Social Impact and Aesthetic Concern domains were significantly higher in patients who reported self-perceived malocclusion (p<0.05). Those with self-perceived malocclusion had significantly higher severity of impacts (p<0.05). Up to 34.7% (n=58) of all subjects reported significant impact on all domains. The difference in extent of psychosocial impacts between subjects who reported self-perceived malocclusion and subjects without self-perceived malocclusion, was statistically significant (p<0.05). 62.4% of subjects with self-perceived malocclusion recorded significant impact in more than 2 domains, whereas 62.1% of subjects who did not report self-perceived malocclusion had significant psychosocial impact in 2 or less domains. Female subjects obtained statistically significant higher mean total scores, and scores for Social Impact and Psychological Impact domains (p<0.05). Higher mean total score in older adolescents was not statistically significant (p=0.151). The effect of race on psychosocial impact was not statistically significant (p=0.101). In conclusion, the prevalence, severity and extent of psychosocial impact of malocclusion on adolescent patients visiting Klinik Pergigian Lanang were high. Those with self-perceived malocclusion had significantly higher severity of impacts.
EFFECTIVENESS OF INTRAORAL RADIOGRAPHY TRAINING KIT FOR DENTAL UNDERGRADUATES: A PRELIMINARY STUDY
Insufficient intraoral radiography training among dental students may lead to an increased radiograph rejection rate at a dental institution which may require a corrective action plan as suggested by the Malaysian Dental Council. The number of trained staff to provide continuous training among dental students in radiographic taking is usually inadequate in most dental institutions, including UKM. To overcome this problem, the intraoral radiography training kit is potentially useful as a self-directed learning aid that students can access anytime for continuous training in intraoral radiography and hence reduce the rejection rate associated with radiographic taking among dental students. This study is aimed to determine the effectiveness of the intraoral radiography training kit and demonstration videos in radiographic taking among dental undergraduates. This type of study is an experimental (parallel group design) to compare the rejection rate between a group of students who are exposed to the radiography training kit (trial group) and a group of students who are not exposed to the intervention (control group). This study involved a convenient sampling of 10 students within the clinical year (Year 4 and Year 5) who had at least one rejected radiograph at undergraduates' polyclinics from March until July 2022. Results showed the mean rank of the radiograph rejection rate in the trial group was lesser than the control group, following the intervention period. In addition, there is a statistically significant difference between the means of radiograph rejection rate before and after exposure to the intraoral radiography training kit (p-value < 0.05). In conclusion, an intraoral radiography training kit is an efficient tool to facilitate dental undergraduates in improving their radiographic skills.