Mobile health applications: awareness, attitudes, and practices among medical students in Malaysia

Background The popularity of mobile health (mHealth) applications (or apps) in the field of health and medical education is rapidly increasing, especially since the COVID-19 pandemic. We aimed to assess awareness, attitudes, practices, and factors associated with the mHealth app usage among medical students. Methods We conducted a cross-sectional study involving medical students at a government university in Sarawak, Malaysia, from February to April 2021. Validated questionnaires were administered to all consenting students. These questionnaires included questions on basic demographic information as well as awareness, attitude toward, and practices with mHealth apps concerned with medical education, health and fitness, and COVID-19 management. Results Respondents had favorable attitudes toward mHealth apps (medical education [61.8%], health and fitness [76.3%], and COVID-19 management [82.7%]). Respondents’ mean attitude scores were four out of five for all three app categories. However, respondents used COVID-19 management apps more frequently (73.5%) than those for medical education (35.7%) and fitness (39.0%). Usage of all three app categories was significantly associated with the respondent’s awareness and attitude. Respondents in the top 20% in term of household income and study duration were more likely to use medical education apps. The number of respondents who used COVID-19 apps was higher in the top 20% household income group than in the other income groups. The most common barrier to the use of apps was uncertainty regarding the most suitable apps to choose. Conclusion Our study highlighted a discrepancy between awareness of mHealth apps and positive attitudes toward them and their use. Recognition of barriers to using mHealth apps by relevant authorities may be necessary to increase the usage of these apps

Clinical Outcome Predictor using Killip Scoring in Acute Decompensated Heart Failure (ADHF): A Non-Cardiac Centre Pilot Experience

Background: Physicians in tertiary centers face a constant challenge in selecting patient with ADHF to be admitted from district healthcare centre, especially with limited resources. Appropriate risk stratification of patients with ADHF would improve the efficiency of our healthcare delivery system. Objective: We aim to find potential relationship between Killip clinical scoring with clinical outcome of ADHF, including in-patient mortality and requirement of advanced cardiorespiratory support. Methods: 35 consecutive cases with a discharge diagnosis of ADHF and admission creatinine clearance of more than 30 were randomly reviewed. Cases were analyzed retrospectively for their Killip score, in-patient mortality, requirement of advance cardiorespiratory care or ICU admission. Results: There were 21 male patients (60%) and 14 female patients. Mean age was 61±19 years old. Mean duration of ward-stay was 6±4 days. Comorbidities were 14 (40%) with history of coronary artery diseases and 17 (49%) with diabetes mellitus. 15 patients (43%) were on at least a single type of guideline directed medication for heart failure. The cohort was almost evenly distributed between those with a Killip score of 2 and above 2. A Killip score of 3 and above was found to have good positive predictive value (87%) for advanced cardio-respiratory care and negative predictive value of 78%. No in-patient death was observed for the group with Killip 2 while 5 deaths were recorded in the group scoring more than 2. A Killip score of 3 had excellent (100%) negative predictive value for in-patient mortality but poor positive predictive value (33%). Significant relationship (p<0.001) was observed for Killip scoring on both outcomes. Conclusion: Killip scoring may be useful for on-call physician to decide the need on tertiary care among patient with ADHF and mortality outcome. However, more prospective studies and patients should be recruited to validate the study

Simple Lifestyle Indicator Questionnaire for Cardiovascular Risk among Medical Students in Malaysia

Background Cardiovascular disease (CVD) is undeniably the leading cause for premature death and contributing huge financial burden for non-communicable diseases (NCDs). Five cardiovascular risk factors involving lifestyle have been identified as physical activity, diet, smoking, alcohol consumption and stress. Identifying the underlying risk of disease is important to manage CVD, subsequently reducing the burden in the developing countries. This study aimed to evaluate the impact on different lifestyle factors determining CVD risk among the medical students. Methods We conducted a cross-sectional study among medical students in a government university in Malaysia. Simple Lifestyle Indicator Questionnaire (SLIQ) was administered to all students and their anthropometric measurements were collected by using calibrated standardized digital weighing scales. Basic demographic data were also collected and all data were analyzed by using the Statistical Package for Social Sciences (SPSS) version 16.0 with statistical significant set at p less than 0.05. 2 Results A total 319 medical students participated in our study with majority of female students (74.6%), single (99.1%) and with mean age of 21 years (standard deviation, SD=1.58). None of them have predisposing chronic medical illness. We found out that almost a quarter of them with high body mass index (BMI) with overweight and obese reported to be 17.9% and 4.7% respectively. From our analysis of SLIQ scoring, 55.8% were classified as intermediate risk for CVD (mean score=6.33, SD= 0.76) and the remaining students with healthy scoring (mean score=8.33, SD=0.54), with p<0.001. Majority consumed moderate healthy diet (55.2%), engaged in vigorous physical activities (57.1%), had intermediate stress level (70.5%) and did not consume alcohol (mean=0.07, SD=0.46) or smoke (96.9%). From our analysis by using Logistic regression, the odds ratio (OR) for overweight group showed 4.3 times healthier lifestyle compared with obese group (p= 0.04). Conclusion SLIQ correlates with healthy lifestyle and can be used as screening tool for CVD risk assessment. The majority of medical students from our study had moderate risk for CVD based on SLIQ scoring and thus, it is important to look into the lifestyle factors that could possibly contributed to the risk. Primary prevention of CVD should be carried out by obesity intervention and lifestyle modification in accordance to global target for better control of NCD

The strategic uses of collagen in adherent cell cultures

The culture of adherent mammalian cells involves adhesion to the tissue culture vessel. This requires attachment factors from serum and/or a suitable substrate on the vessel surface. Some cells require collagen or other substrates to promote neurite outgrowth, differentiation or growth. However, laboratories often lack guidance on the selection and/or optimisation of collagen. We model such selection/optimisation work in the PC12 neuronal cell line. PC12 (NS-1 variant) cells require a substrate for adherence. Comparing cell attachment against a series of substrates, we found collagen IV to be optimal. We show by comparison of morphology against a range of concentrations that 10 µg/ml is sufficient for supporting cell attachment, and also differentiation. PC12 cells from Riken Cell Bank do not require a substrate for routine culturing but only for differentiation. As all substrates supported attachment equally well, we used a novel serum-free approach and identified collagen IV as its preferred substrate. For these cells, Dulbecco's modified eagle's medium but not Roswell Park Memorial Institute (RPMI) media supports normal cell attachment. However, coating with collagen IV enabled the cells to grow equally well in RPMI. Hence the strategic use of collagen is essential in laboratories working with anchorage-dependent cell lines

Phytochemicals from Calophyllum canum Hook f. ex T. Anderson and their neuroprotective effects

Previous phytochemical investigations reported that Calophyllum spp have biosynthesized a wide range of bioactive phenolics such as xanthones and coumarins. The phytochemical study conducted on the stem bark of C. canum has led to the isolation of eight trioxygenated xanthones namely: 5-methoxytrapezifolixanthone (1), 5-methoxyananixanthone (2), caloxanthone C (3), 1,5-dihydroxy-3-methoxy-4-isoprenylxanthone (4), 6-deoxyisojacareubin (5), euxanthone (6), trapezifolixanthone (7), ananixanthone (8), together with three common triterpenoids, β-sitosterol (9), friedelin (10), and stigmasterol (11). Furthermore, xanthones 1 and 2 were isolated for the first time as naturally occurring xanthones from the plant extract. The structures of these compounds were identified and elucidated using advanced spectroscopic techniques such as 1 D & 2 D NMR, MS, and FTIR. The neuroprotective property of selected compounds was tested through in vitro stroke model. Among all tested compounds, 1 µm of compounds 8, 9, and 10 showed significant neuroprotective activity via reduction of apoptosis by ∼ 50%