Functional and Radiological Outcomes of Plate Osteosynthesis in Closed Displaced Intraarticular Calcaneal Fractures

INTRODUCTION: Calcaneum fractures, particularly closed, displaced intraarticular fractures, are uncommon yet cause significant morbidity and impair quality of life (QOL). While open reduction and internal fixation a standard treatment, debate on optimal management continues. This study evaluated functional outcomes of plate osteosynthesis for these fractures, focusing on QOL and radiological measures. MATERIALS AND METHODS: This retrospective study reviewed records of patients with closed displaced intraarticular calcaneal fractures treated with plate osteosynthesis (January 2015-December 2020) at a single tertiary centre. Surgery involved open reduction and internal fixation using a locking calcaneal plate, performed on average 11 days post-trauma. Follow-up assessments were conducted for a minimum of one year, utilising the SF-36 for QOL and measuring Böhler’s angle. RESULTS: Twenty-six patients (25 males, 1 female; mean age 42.8 years) were included. Fractures were primarily caused by motor vehicle accidents (65.4%). The mean QOL score was 55.9, and the mean post-operative Böhler’s angle was 22°. Fracture type (Sanders’ classification) was significantly associated with Böhler’s angle. Correlation analysis revealed a weak, non-significant positive correlation between Böhler’s angle and SF-36 scores (r = 0.187, r² = 0.035, p = 0.360). Superficial infections occurred in 7.6% of cases, all resolving without further surgery. CONCLUSION: Plate osteosynthesis for closed, displaced intraarticular calcaneum fractures provides favourable functional outcomes and restores anatomical alignment. The weak correlation between radiological restoration and patient-reported function suggests that additional factors may influence overall recovery

An Investigation on Body Composition, Bone Parameters, Physiological Function, Quality of Life and Cancer-Related Fatigue in Malaysian Breast Cancer Survivors

INTRODUCTION: The aim of the study is to determine the correlation of body composition, bone parameters, physiological functions, with the quality of life (QoL) and cancer-related fatigue (CRF) among Malaysian breast cancer survivors. MATERIALS AND METHODS:  Eighty-three female breast cancer survivors participated. Assessments of body composition, bone speed of sound (SOS), and T-score. Physiological functions consisted of handgrip strength, shoulder and lower body flexibility, and peak expiratory flow rate (PEFR) were performed on the participants. The Breast Cancer Functional Assessment of Cancer Therapy questionnaire was used for determining their QoL, while the Brief Fatigue Inventory scale questionnaire was used for assessing the CRF.Descriptive statistics and Pearson correlation were performed for statistical analysis. RESULTS: The mean T-score value for the right and left radius and tibia of the participants ranged between -1 and -2.5 SD, i.e., under the osteopenia category. There was no significant correlation between the percentage of body fat and fat-free mass with components of QoL and CRF, respectively. In addition, statistically significant positive correlations of bone SOS with components of QoL were not evidenced. A significant negative correlation was found between left handgrip strength and CRF (r=–0.240, p=0.032). However, no statistically significant correlations were observed between shoulder and lower body flexibility or PEFR with components of QoL and CRF, respectively. CONCLUSION: Higher handgrip strength of participants was related to lower CRF. Thus, the aspect of improvement of muscular strength of the arm should be emphasized while designing interventions for rehabilitation among breast cancer survivors

Two-Dimensional Radiological Analysis of Tibial Malalignment After Intramedullary Nailing: Prevalence, Associated Factors, and Outcomes

INTRODUCTION: Tibial fractures are common long-bone fractures treated by orthopaedic surgeons. Intramedullary nailing (IMN) is the preferred standard treatment for tibial diaphysis fractures. This study aimed to evaluate the prevalence of tibial malalignment, its associated factors, and the outcomes following IMN. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted on skeletally mature patients aged over 18 years who underwent IMN for tibial diaphysis fractures at a single academic trauma centre from January 2015 to December 2023. Data were extracted from the hospital database, including plain radiographs, medical records, and intraoperative notes. The Pearson chi-square test was used to examine the outcomes of malalignment, followed by logistic regression analyses to identify factors associated with tibial malalignment. RESULTS: A total of 163 patients were analysed. The prevalence of tibial malalignment following IMN was 66.0% in the proximal third, 58.8% in the distal third, and 25.0% in the middle third. The degree of comminution, specifically in Type 42C fractures, and lateral nail entry point were significantly associated with malalignment (p=0.02 and 0.011, respectively). However, no significant correlation was found between malalignment and bone union. CONCLUSION: Tibial malalignment is most common in the proximal third following IMN, with the degree of comminution being a significant factor. Despite the high prevalence of malalignment, it did not adversely affect bone union. These insights can guide preoperative planning and intraoperative techniques to optimize patient outcomes in tibial diaphysis fractures.

Agarwood's Role in Inflammatory-related Conditions: A Systematic Review of Animal Models

Agarwood (Aquilaria spp.) is a resinous wood traditionally used in various medicinal systems across Asia for treating inflammation-related ailments. Despite its longstanding ethnopharmacological use, scientific validation of its anti-inflammatory effects remains fragmented. This scoping review aims to systematically evaluate and synthesize current evidence from animal studies investigating the anti-inflammatory potential of agarwood. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science. Inclusion criteria focused on original animal studies assessing the anti-inflammatory effects of agarwood extracts, essential oils, or derivatives. Data on study design, animal models, agarwood species, treatment dosage, duration, biomarkers, and outcomes were extracted and summarized narratively due to methodological heterogeneity. Eight studies met inclusion criteria, involving models of inflammation-related conditions such as pain, neuroinflammation, gastrointestinal injury, cancer, and toxicity. Agarwood treatment consistently reduced pro-inflammatory cytokines (e.g., IL-1β, IL-6, TNF-α), modulated oxidative stress markers (e.g., NO, SOD, GSH), and regulated signalling pathways including NF-κB, p38 MAPK, and Nrf2–ARE. Notably, improvements were observed in behavioural and histological outcomes across models, with evidence of dose-dependent effects in several studies. In conclusion, preclinical evidence supports agarwood’s broad-spectrum anti-inflammatory and antioxidant properties across multiple organ systems. These findings provide mechanistic insights and a scientific basis for its traditional  use. However, variability in species, extraction methods, and study designs highlights the need for standardised protocols and clinical validation to advance agarwood as a potential therapeutic agent.

A Case-Control Study to Assess Vision-Related Quality of Life in Patients With and Without Diabetic Retinopathy from a Multiethnic Population in Malaysia

INTRODUCTION: Diabetic patients are exposed to information regarding diabetic eye complications and may therefore be aware of visual function problems even when diabetic retinopathy (DR) is absent or minimal. Hence, it is important to assess vision-related quality of life (VRQL) even in patients with no orminimal DR and preserved visual acuity. MATERIAL AND METHODS: This observational, matched case-control study involved diabetic patients aged above 45 years. The VRQL was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25, version 2000). Multiple linear regression analysis was performed to compare VRQL between cases and controls after adjusting for age and gender. RESULTS: After adjustment for age and gender, cases had a significantly lower general health score than controls (mean difference -16.33; 95% CI -19.99 to -13.45; p<0.001). Near-activity scores were also significantly lower among cases (mean difference -5.32; 95% CI -8.23 to -2.41;) p<0.001). Although cases demonstrated a lower composite VRQL score, the difference was not statistically significant (b -0.71, 95% CI -3.57 to 2.15;p>0.05). CONCLUSION: This study showed VRQL is more strongly associated with visual acuity than with the stage of diabetic retinopathy. Hence, we recommend comprehensive counselling regarding vision-related issues to all patients with diabetes

Development and Validation of A Weight Management Program Model for Overweight and Obese Individuals

INTRODUCTION: Developing a structured and theory-based model can enhance the effectiveness of weight management program. However, the underlying model requires validation to ensure its accuracy and applicability. Therefore, this study aimed to demonstrate the development and validation process of a weight management program model for overweight and obese individuals. MATERIALS AND METHODS: A weight management program model was previously developed using thematic analysis and scoping review by utilizing Theory of Change as the framework. Seven experts were invited to evaluated using the content validity index through online questionnaire, comprising 42 items, and provided feedback on its features for face validity. RESULTS: The developed model structured with 6 domains, 6 constructs, and 23 sub-constructs. More than 85.71% of the experts agreed on the face validity of the developed model. The content validity result indicated that the experts reached a consensus on all 6 domains. The modified kappa represented excellence in all 6 domains, with a k* value of 0.97-1.00. Meanwhile, the S-CVI/Ave and S-CVI/UA values ranged from 0.97-1.00 and 0.80-1.00, respectively. Several experts suggested  ideas and recommendations for improvement. The validation led to all items being accepted without elimination. CONCLUSION: The weight management program model has been validated, and all 6 domains were retained following expert validation. This model is expected to provide insightful and valuable guidance  for future practitioners in planning and executing weight management programs among individuals with overweight and obesity issues

In-Silico and In-Vitro Assessment of Selected Fatty Acids against Vibrio Spp..

INTRODUCTION: Vibrio spp. is a zoonotic pathogen that can cause mild or fatal infection in human and animals. The overuse of antibiotics has led to increasing antimicrobial resistance (AMR). Fatty acids (FAs) offer a potential alternative due to their broad-spectrum antibacterial activity. Hence, this study aimed to investigate the anti-Vibrio effects of oleic acid (OA), lauric acid (LA), palmitic acid (PA), and stearic acid (SA) through in-vitro and in-silico approaches. MATERIALS AND METHODS: Molecular docking was performed using PyRx against 21 receptors belonging to Vibrio spp. retrieved from the Protein Data Bank (PDB) for in-silico investigation. To validate the findings, LA, OA, PA and SA were experimentally tested. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) assays were conducted in-vitro against Vibrio alginolyticus and Vibrio parahaemolyticus. RESULTS: Molecular docking results revealed that OA exhibited the lowest binding energy (min=-7.2, mean=-4.8). OA also showed the second-highest number of hydrogen bond interactions and ranked third in van der Waals interactions. FAs demonstrated significantly stronger affinity (p<0.05) to proteins related to toxin production, nutrient acquisition, and quorum sensing. In-vitro assays aligned with in-silico where OA had the lowest MIC (125 µg/mL) against both V. alginolyticus and V. parahaemolyticus and exhibited bactericidal activity against V. alginolyticus at 500 µg/mL. CONCLUSION: Therefore, OA is a promising anti-Vibrio agent that might regulate environmental sensing and interaction with small molecules. The receptors 3MRU, 3WPW, 3A57 and 3X0T, matched in-vitro results and could be used in the design of new treatments for vibriosis.

Comparative Evaluation of ChatGPT and Microsoft Copilot in Solving Clinical Vignette- style multiple-choice questions (MCQs) in Physiology

INTRODUCTION: Large language models (LLMs) are increasingly used by MBBS students as supplementary resources for exam preparation. The objective of this study was to evaluate the performance of ChatGPT and Microsoft Copilot in answering clinical vignette-style physiology MCQs from widely used resources for the United States Medical Licensing Examination (USMLE). MATERIALS AND METHODS: Fifty clinical vignette-style physiology multiple choice questions (MCQs) from the various USMLE question banks were submitted to ChatGPT and Microsoft Copilot to choose the correct option. The performance of ChatGPT and Microsoft Copilot was assessed using the provided answers in the question bank. Two experienced physiologists independently reviewed the explanations provided by ChatGPT and Microsoft Copilot for each MCQ. The explanations were rated between one to three points based on whether the answers were completely incorrect, partially correct with inaccurate information, or correct with adequate information. RESULTS: ChatGPT and Microsoft Copilot both correctly answered 48 and 47 out of 50 questions, reflecting a 96% and 94% accuracy rates respectively. One MCQ each on hypothyroidism and arrhythmia was incorrectly answered by both ChatGPT and Microsoft Copilot. For two MCQs, the explanations provided were inaccurate by ChatGPT and Microsoft Copilot provided inaccurate explanations for four of the MCQs. CONCLUSION: ChatGPT and Microsoft Copilot both demonstrated more than 90% accuracy in answering case-based MCQs from the USMLE Step 1 resources. Their incorrect option choices MCQs on hypothyroidism and inaccurate explanations for some MCQs highlight cautious use of AI by students

Prevalence of Erectile Dysfunction & Its Associated Factors among Nondiabetic Overweight and Obese Patients Attending Government Health Clinic in Kuantan, Pahang.

INTRODUCTION: In the clinical setting, erectile dysfunction (ED) is a significant issue that should not be neglected, as it can adversely impact the quality of life of patients and their partners, especially among overweight and obese populations. This study aims to determine the prevalence of ED and its associated factors among non-diabetic, overweight, and obese patients who attend a government health clinic in Kuantan, Pahang, Malaysia. MATERIALS AND METHODS: A six-month cross-sectional study was conducted from February 2024 to August 2024 at twelve health clinics in Kuantan, Pahang. The selected respondents were married men over 18 years old, and those with diabetes mellitus, cardiovascular disease, psychiatric illness, or illiteracy were excluded. Data were collected using the validated Malay version of the International Index of Erectile Function (IIEF-5). ED was defined as an IIEF-5 score of less than 22. Descriptive analysis and simple and multiple logistic regression were performed using SPSS. RESULTS: All 221 eligible patients in the study responded (100% response rate). The prevalence of ED was 66.1% (n=146). Multiple logistic regression              showed that ED was significantly associated with dyslipidemia [AOR (95% CI): 2.42              (1.06–5.52); p-value=0.036], anxiety [AOR (95% CI): 3.99 (1.44–11.01);  p-value=0.008] and older age [AOR (95% CI): 1.07 (1.02–1.12); p-value=0.009]. CONCLUSION: The study revealed a high prevalence of ED among non-diabetic overweight and obese patients, potentially linked to increasing age, dyslipidemia, and anxiety. Increasing awareness among the public and healthcare providers could improve detection rates in primary care.

Recent Updates on the Mechanism of Action of Spirulina as an Anticancer Agent against Breast Cancer

Spirulina, a small blue-green algae that lives in warm, alkaline seas, is one of the world's oldest life forms. With century-old history, this nutrient-rich organism has received a lot of interest in recent years for its possible health benefits and sustainable production practices. Studies have indicated its antioxidant, anti-cancer, and anti-inflammatory qualities are contributed by its bioactive compounds, mainly phycocyanin. Other compounds or elements include phycocyanobilin, carotenoids, unsaturated fatty acids, selenium, and amino acids. Breast cancer is one of the major causes of cancer related death in women. As some of the cancer therapies are highly associated with side effects, nutraceuticals such as Spirulina could be an alternative therapeutic intervention. Although some research has been conducted to investigate the anti-breast cancer effects of Spirulina in the past, its mechanism of action is not entirely understood. Previous studies suggest that it may trigger apoptosis and autophagy via modifying signalling pathways such as NF-κB and Bcl-2/Bax ratio. It also has anti-proliferative properties, inhibits cell migration, causes cell cycle arrest, and lowers cancer cells' capacity to form colonies. Phycocyanin has been shown to produce reactive oxygen species (ROS) and down-regulate anti-apoptotic molecules, which contribute to its anticancer capabilities. These findings show that Spirulina fights cancer by targeting a variety of cellular mechanisms involved in carcinogenesis. While these data imply potential benefits, more clinical trials and research into the exact mechanisms of Spirulina in cancer treatments are needed to fully demonstrate its efficacy in treating breast cancer in humans.