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The article presents a study that determined the relationship of level of religious commitment and coping methods with distress level among psychiatric outpatients of the University Malaya Medical Centre in Kuala Lumpur, Malaysia. Majority of patients were male, Malay, Muslim, single with psychotic disorder. The study found that high religious commitment in patients was linked to a lower distress level. Negative religious coping and psychiatric symptoms were linked to a higher distress level.

Spray drying fruit juice powders poses challenges because sugars and organic acids with low molecular weight and a low glass transition temperature inherently cause stickiness. This study employed a hydrophobic polytetrafluoroethylene (PTFE) film to mimic the surface of the drying chamber wall. The Central Composite Design (CCD) using response surface methodology investigated the impact of power (X1, Watt) and the duration of oxygenated plasma treatment (X2, minutes) on substrate contact angle (°), reflecting surface hydrophobicity. To validate the approach, Morinda citrofolia (MC) juice, augmented with maltodextrins as drying agents, underwent spray drying on the improved PTFE-coated surface. The spray drying process for MC juice was performed at inlet air temperatures of 120, 140, and 160°C, along with Noni juice-to-maltodextrin solids ratios of 4.00, 1.00, and 0.25. The PTFE-coated borosilicate substrate, prepared at a radio frequency (RF) power of 90W for 15 minutes of treatment time, exhibited a porous and spongy microstructure, correlating with superior contact angle performance (171°) compared to untreated borosilicate glass. Optimization data indicated that the PTFE film attained an optimum contact angle of 146.0° with a specific combination of plasma RF operating power (X1 = 74 W) and treatment duration (X2 = 10.0 minutes). RAMAN spectroscopy indicated a structural analysis with an ID/IG ratio of 0.2, while Brunauer-Emmett-Teller (BET) surface area analysis suggested an average particle size of less than 100 nm for all coated films. The process significantly improved the powder's hygroscopicity, resistance to caking, and moisture content of maltodextrin-MC juice. Therefore, the discovery of this modification, which applies oxygen plasma treatment to PTFE-coated substrates, effectively enhances surface hydrophobicity, contact angle, porosity, roughness, and ultimately improves the efficacy and recovery of the spray drying process., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Abidin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Vortioxetine is a monoaminergic drug with a novel multimodal mechanism of action. We investigated its efficacy on depressive symptoms, cognitive function, and quality of life among cancer patients., Methods: In this multicenter, open-label, single-arm, observational study, patients received flexible doses of Vortioxetine for a period of six months. All participants were assessed at baseline and scheduled for monitoring at weeks 2, 4, 8, 12, 16, 20, and 24. Depression severity was assessed using Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI) scale. The Perceived Deficiency Questionnaire (PDQ-5) assessed the perceived cognitive difficulties in concentration, executive functioning, and memory. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) was used to assess the patients' quality of life. Side effects of vortioxetine were monitored using the Antidepressant Side-Effect Checklist (ASEC)., Results: Patients experienced a reduction in MADRS scores from 29.89 ± 5.997 at baseline to 11.59 ± 4.629 by Week 24. The PDQ-5 scores showed significant change from Week-4, whereas the EORTC role, emotional, and cognitive functioning scores showed a significant change from Week 2 onwards. CGI-Severity scores decreased from a baseline of 4.39 ± 0.746 to 2.41 ± 1.085 by Week 24. During the 24-Weeks of therapy, around three-quarters of the patients (73.3%) had one or more adverse events reported on the ASEC. The most frequently reported TEAEs were dry mouth, insomnia, somnolence, and headache, with more than a 30% incidence rate., Conclusion: Vortioxetine seems promising in the management of depression and enhancement of cognitive function and quality of life of cancer patients with Major Depressive Disorder., .

This study aimed to evaluate the validity of the Beck Depression Inventory (BDI-II) as a screening tool for depression among Kazakh-speaking female cancer patients. A cross-sectional study design with random sampling was used to collect and analyze data from 115 female cancer patients. Means, sensitivity, specificity, and positive and negative predictive values were calculated. An analysis of receiver operating characteristic (ROC) curves was conducted to determine the optimal cut-off score for the BDI-II in this population as a screening tool for depression. Test-retest reliability and internal consistency were also tested. Results showed that using a BDI-II cut score of 15 retained high sensitivity (82.7%), increased specificity (75.0%), and improved positive (86.1%) and negative predictive values (69.8%) of the BDI-II compared to a cut score of 14. Kazakh BDI-II indicated excellent consistency (Cronbach's alpha of 0.86) and reliability (intraclass correlation coefficient (ICC) of 0.92 (95% CI [0.89-0.94])). The use of this valid screening tool can facilitate the diagnosis of depression in female cancer patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Self-care education can direct patients to manage their side effects during treatment, reduce psychological distress, and improve self-care information. In this study, the effectiveness of the Self-Care Education Intervention Program (SCEIP) on patient activation levels, psychological distress, and treatment-related concerns in women with breast cancer was assessed by adopting a longitudinal quasi-experimental pre-test and post-test design. The data for 246 women with breast cancer undergoing adjuvant chemotherapy were collected. Pre- and post-interventional assessments were conducted at baseline (T1) and the second (T2), fourth (T3), and sixth (T4) cycles using the 13-item Patient Activation Measure, 14-item Hospital Anxiety and Depression Scale, and 25-item Cancer Treatment Survey. It was found that the SCEIP significantly improved the activation level ( p ≤ 0.001), psychological distress (anxiety level ( p ≤ 0.001), the depression level ( p ≤ 0.001)), and treatment-related concerns (sensory/psychological concerns ( p = 0.05); procedural concerns ( p ≤ 0.001)). Therefore, the SCEIP could potentially improve patients' activation level, psychological distress, and treatment-related concerns regarding symptom management during chemotherapy, specifically for Malaysian women with breast cancer., Competing Interests: The authors declare no conflict of interest.

Introduction: Diagnosis of breast cancer is associated with high psychological distress. There is a lack of studies examining the prevalence of anxiety among newly diagnosed breast cancer patients in Kazakhstan., Objective: This study aims to assess the mean prevalence and associated sociodemographic and clinical factors of anxiety symptoms in women newly diagnosed with breast cancer. It also aims to determine independent predictors of anxiety risk., Methods: An analysis of 162 newly diagnosed breast cancer patients at the oncology institute in Almaty was performed. Data were collected using a structured questionnaire on social, demographic, and clinical information, as well as the Beck Anxiety Inventory. In addition, multiple regression analysis was used to model the relationship between anxiety risk and independent predictors., Results: The average age of the patients was 54.41 years (SD=8.1; min.-max: 32-75). The majority of the patients were married (52%), employed or self-employed (51%), had children (91%), had a bachelor's or a graduate degree (50%), lived in an urban area (54%), did not drink (41%), did not smoke (67%), did not engage in physical activity (54%), and had social support (91%). A total of 48% of patients had symptoms of moderate anxiety, and 33% had symptoms of severe anxiety. Based on the multivariate analysis, factors associated with a lower risk of anxiety symptoms included higher household income (OR -2.21 (95 CI: -1.35, -3.07)) and having reliable social support (OR -2.93 (95% CI: -2.25, -3.61))., Conclusion: The prevalence of anxiety symptoms is very high among newly diagnosed breast cancer patients. Anxiety is more likely to develop in patients from low-income households and those without reliable social support.

Introduction: Diagnosis of breast cancer is associated with the presence of psychological disorders including depression. There is a lack of study examining the prevalence of depression among newly diagnosed breast cancer patients in Kazakhstan., Objective: This study aims to assess the prevalence and associated sociodemographic and clinical factors of depression symptoms in women newly diagnosed with breast cancer., Methods: 162 newly diagnosed breast cancer patients at the oncology center in Almaty were recruited for this study. Data were collected using a structured questionnaire on sociodemographic and clinical information and the Beck Depression Inventory-II scale., Results: The mean age of the patients was 54.41 years (SD=8.1). 95% of participants had unilateral breast cancer, and 79% of participants had stage I or stage II breast cancer. 73% of patients said that they do not have reliable social support. 46% of patients had symptoms of moderate depression, and 31% of patients had symptoms of severe depression. According to the multivariate analysis, factors associated with depression symptoms were: social status, household income level, reliability of social support, and stage of breast cancer., Conclusion: The prevalence of depression symptoms is very high among newly diagnosed breast cancer patients. Unemployed or retired patients, with a lower household income, and no reliable social support diagnosed with an advanced stage of breast cancer are especially at high risk for developing depression.

The purpose of this paper is to determine the performance of employees employed at home during the COVID-19 pandemic in Malaysia and Indonesia, also to examine the employee's quality of life affected by COVID-19. The current study is aimed to critically determine the performance of employees employed at home during the COVID-19 pandemic. The author has analyzed and reviewed various sources of articles, reports, and documents from previous research and literature. The findings explain that working from home has provided advantages and disadvantages for both the employees and the organization and is responsible for the decrease in employee productivity. In addition, the findings conclude that the fact that working from home is generally not feasible because many areas of work cannot be done from home, although for many employees, working from home has provided a work-life balance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abiddin, Ibrahim and Abdul Aziz.)

The psychological distress reported among frontline healthcare workers (HCWs) is concerning. Little is known about the mental health of non-frontline, psychiatric HCWs, who play a central role in handling the mental health crisis during the COVID-19 pandemic. This study aimed to examine the prevalence of anxiety and depression among psychiatric HCWs and evaluate its association with socio-demographic, socio-economic, work-related factors and coping strategies. The authors proposed a cross-sectional study design using the Hospital Anxiety and Depressive Scale (HADS) and Brief-COPE scale. This study found that the prevalence of anxiety and depression were 22.0% and 16.8%, respectively. A multivariate analysis revealed that married psychiatric HCWs had a lower level of anxiety with OR = 0.31 (95% CI: 0.11-0.83). Psychiatric HCWs who were experiencing financial hardships, were unvaccinated and those who had a shorter duration of service in the psychiatric department had a higher level of depressive symptoms with OR = 0.31 (CI: 1.19-11.27), 3.21 (CI: 0.97-10.52), and 1.01 (CI: 1.00-1.02), respectively. For every increase of one unit of avoidant coping score among respondents, the odds of having anxiety and depression increased by 1.25 times (CI: 1.15-1.37) and 1.20 times (CI: 1.09-1.32), respectively, whereas for every increase of one unit of religious coping score among respondents, the odds of having anxiety reduced by 1.42 times (CI: 1.10-1.84). The authors highlight that psychosocial measures addressing the relatively high levels of anxiety and depression among psychiatric HCWs should be a key priority to ensure the sustainment of mental health services in the face of this prolonged pandemic.

Numerous studies have reported the vast medicinal values of proteins from mushrooms. The present study aimed to investigate the potential of protein extracts from the sclerotium of Pleurotus tuber-regium (Fr.) Singer for antitumor activities against a breast cancer cell line. Protein from P. tuber-regium sclerotium was fractionated using ammonium sulphate at concentrations of 30%, 60%, and 90% and designated as PS30, PS60, and PS90, respectively. All protein extracts were assessed for cytotoxicity toward breast cancer cell line MDA-MB-231 and normal lung fibroblast cell line MRC-5 in the MTT assay. The ability of the protein extracts to inhibit cellular migration was evaluated using the antimigration assay. The most promising protein extract against MDA-MB-231 cells was PS60, with a half-maximal inhibitory concentration of 0.75 ± 0.57 μg/mL and a selectivity index of 14.00. Cytotoxicity and antimigration effects on cancer cells were best exhibited by PS60, with absolute migration capability values between 5.4142 ± 0.6916 and 5.6581 ± 0.2015 nm/h. PS60 was shown to exert cytotoxic effects associated with the induction of apoptosis and cell cycle arrest in MDA-MB-231 cells at G1/G0 and S phase. In conclusion, PS60 protein of P. tuber-regium sclerotium has good potential to be developed into a novel antitumor drug against breast cancer.

In targeted therapy, proteins/peptides are expected to be more effective as anticancer and/or antitumor agents. Our previous study showed that the protein fraction of Pleurotus tuber-regium (Fr.) Singer sclerotia (PS60) possesses significant cytotoxic activity against the MDA-MB-231 breast cancer cell line, with a 50% inhibitory concentration (IC50) of 0.75 ± 0.57 μg/mL. The current study aimed to further separate and characterize cytotoxic PS60 proteins from P. tuber-regium sclerotia toward MDA-MB-231. The separation of PS60 was conducted using fast protein liquid chromatography. The MTT assay was used to analyze the cytotoxic activity of the protein peaks separated from PS60. Then all of the protein peaks were characterized using liquid chromatography quadrupole time-of-flight mass spectrometry analysis. Three protein peaks (Q1, Q2, and Q3) were successfully separated from PS60. Both the PS60 and protein peaks have shown significant cytotoxic effects against MDA-MB-231 cell growth, with an IC50 < 1.00 μg/mL. Cytotoxic proteins were identified and characterized as kinesin-like protein and keratin type 1, cytoskeletal 10. Several potential cytotoxic proteins from P. tuber-regium sclerotia reactive against MDA-MB-231 breast cancer cells were identified.

Nontuberculous mycobacteria (NTM) infection is of growing concern in cystic fibrosis (CF). UK CF Registry data were analyzed from 2016 to 2018. Prevalence of infection stabilized in the pediatric age-group during this period but remained substantially higher than in 2010. Allergic bronchopulmonary aspergillosis and Pseudomonas aeruginosa infection were associated with NTM infection., Competing Interests: Declaration of Competing Interest None relating to this work. M.B. unrelated to this work, received investigator-led research grants from Pfizer and Roche Diagnostics; honoraria for speaking at educational meetings paid to Newcastle University from Novartis, TEVA and Roche Diagnostics; and travel and accommodation for educational meetings from Boehringer Ingelheim and Vertex Pharmaceuticals. M.F.T. unrelated to this work, received an investigator-led research grant from Pfizer. All remaining authors: No reported conflicts of interest., (Copyright © 2020. Published by Elsevier B.V.)

Curculigo is a potent plant with a variety of traditional uses, such as anti-oxidant, anti-diabetic, anti-tumor, anti-bacterial, anti-cancer, anti-osteoporosis, and wound-healing. The comprehensive profiling of the Curculigo latifolia metabolome was carried out by generating a molecular network (MN) from Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) data to profile the methanol extract and correlating them with their antioxidant (2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH), total phenolic contents (TPC), and β-carotene) and antimicrobial (disk-diffusion agar method, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC)) properties. The antioxidant capacity was observed to be significantly higher in the rhizome crude extract, with 18.10 ± 0.91 µg/mL DPPH activity, and a β-carotene bleaching result of 35.20%. For the antimicrobial activity, the leaf crude extract exhibited a strong Staphylococcus aureus and Salmonella choleraesuis (8-15 ± 3.0 mm) inhibition in the disk-diffusion agar. The leaf extract also exhibited maximum antibacterial activity against S. aureus (MIC = ±0.25 mg/mL, MBC = ±0.25 mg/mL) and S. choleraesuis (MIC = ±0.25 mg/mL, MBC = ±0.25 mg/mL). LC-MS/MS analysis and MN revealed norlignans and phenolic glycosides as major metabolites in the rhizome and leaf extracts of the negative mode (M - H) - . Fourteen known compounds were identified, and three unknown compounds were putatively identified in the rhizome extract, while ten known compounds and six unknown compounds were putatively identified in the leaf extract.

Objective: Long-term social distancing, isolation, and economic fallout may be significant psychological triggers during pandemic, such as COVID-19, especially for those with underlying psychiatric illness. This study was conducted to address the psychological impact of COVID-19 pandemic among patients with depression based at a teaching hospital in Malaysia., Methods: This is a cross-sectional online study among patients with depression from University Malaya Medical Centre, using Generalized Anxiety Disorder-7 (GAD-7), Montgomery-Åsberg Depression Rating Scale-Self Assessment (MADRS-S), Insomnia Severity Index (ISI), Multidimensional Scale of Perceived Social Support (MSPSS), Knowledge, Attitudes, and Practices (KAP), and Social Media Addiction during COVID-19 Pandemic (SMACOP)., Results: One hundred seventy-eight patients participated in this study. The mean total of the KAP score is 12.65 (SD = 2.65), with knowledge section (mean = 7.34 [SD = 2.13]), attitudes section (mean = 2.63 [SD = 0.58]), and practices section (mean = 2.69 [SD = 1.00]). They scored moderately on the MADRS-S (mean = 21.03 [SD = 4.62]) and ISI (mean = 20.25 [SD = 4.62]) but had high GAD-7 scores (mean = 16.8 (SD = 6.27]). From the multiple logistic regression analyses, depressive symptoms of greater severity (MADRS-S 18-34) are significantly associated with more severe insomnia ( P < .001, adjusted OR = 9.101, 95% CI: 3.613-22.924). Furthermore, the high anxiety level is associated with the younger age group ( P = .029, Adjusted OR = 2.274, 95% CI: 1.090-4.746), greater severity of insomnia ( P < .001, Adjusted OR = 22.9, 95% CI: 6.145-85.343), and higher risk of COVID-19 related social media addiction ( P = .011, adjusted OR = 2.637, 95% CI: 1.253-5.550)., Conclusion: This study demonstrates the high levels of sleep disturbances and anxiety symptoms experienced by outpatients with depression during the COVID-19 pandemic. These are closely linked to the younger age group and at-risk social media addiction related to COVID-19., Competing Interests: Conflict of Interest: The authors have no conflict of interest to declare., (© Copyright 2021 authors.)

Objective: This study aims to determine the prevalence of depression, trait anxiety, and social support among women suspected of breast cancer (BC) and to investigate the association of these factors with the diagnosis of BC., Methods: A cross-sectional study was conducted on 745 women who presented with breast symptoms in a university breast clinic in Malaysia. Participants were instructed to respond to self-report questionnaires on depression, trait anxiety, and social support while they were waiting for assessment of their suspected BC. The final diagnoses of these patients were traced one month after examining their medical records. Descriptive statistics were performed to examine the socio-demographic and clinical characteristics of all participants. A multiple regression analysis was carried out to determine the association of the abovementioned factors with the diagnosis of BC., Results: The analysis showed that BC was diagnosed in 109 (14.6%), benign breast disease (BBD) in 550 (73.8%), and healthy breast (HB) in 86 (11.5%) women. The prevalence of depression was 53.2% in women with BC, 53.6% in women with BBD, and 60.5% in women with HB prior to diagnosis. The prevalence of trait anxiety was 33%. Mean scores for trait anxiety were 42.2 ± 9.0 and 41.8 ± 9.1 for the BC group and BBD group, respectively. The level of perceived social support was similar in all three groups., Conclusion: We found no significant difference in depression, trait anxiety, and social support among women with newly diagnosed BC, BBD, and HB in women with breast symptoms while undergoing diagnostic evaluation. A longitudinal study is essential to establish the association between chronic mental stress and BC., (© 2021 The Authors.)

Purpose: This study examined the efficacy of a brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy., Methods: Data collection was carried out in 3-time points: baseline (T1), screening (T2), and post-treatment (T3). Respondents who had significant subjective cognitive impairment were randomly divided into two groups: intervention (n = 30) and waitlist (n = 30). Respondents in the intervention group received 4 sessions of 1 hour of ACT therapy., Findings: Respondents in the intervention group showed significant improvement in subjective cognitive impairment, depression, anxiety, and psychological inflexibility after the ACT intervention ( p  < 0.05). After controlling the covariates, group differences in all variables were significant except for fatigue and psychological inflexibility has the highest effect size ( d  = 4.69)., Conclusion: ACT could be considered as an effective intervention to ameliorate subjective cognitive impairment, anxiety, depression, and psychological inflexibility in breast cancer patients undergoing chemotherapy., Implications for Psychosocial Providers: This study highlights the importance of screening for subjective cognitive impairment in breast cancer patients undergoing chemotherapy and heightens their opportunity to receive proper management as earlier as possible.

Background: Tuberculosis (TB) is still a major health problem in Malaysia with thousands of cases reported yearly. This is further burdened with the emergence of multidrug-resistant TB (MDR-TB). Whole-genome sequencing (WGS) provides high-resolution molecular epidemiological data for the accurate determination of Mycobacterium tuberculosis complex (MTBC) lineages and prediction of the drug-resistance patterns. This study aimed to investigate the diversity of MTBC in Malaysia in terms of lineage and drug-resistance patterns of the clinical MTBC isolates using WGS approach., Methods: The genomes of 24 MTBC isolated from sputum and pus samples were sequenced. The phenotypic drug susceptibility testing (DST) of the isolates was determined for ten anti-TB drugs. Bioinformatic analysis comprising genome assembly and annotation and single-nucleotide polymorphism (SNP) analysis in genes associated with resistance to the ten anti-TB drugs were done on each sequenced genome., Results: The draft assemblies covered an average of 97% of the expected genome size. Eleven isolates were aligned to the Indo-Oceanic lineage, eight were East-Asian lineage, three were East African-Indian lineage, and one was of Euro-American and Bovis lineages, respectively. Twelve of the 24 MTBC isolates were phenotypically MDR M. tuberculosis: one is polyresistance and another one is monoresistance. Twenty-six SNPs across nine genes associated with resistance toward ten anti-TB drugs were detected where some of the mutations were found in isolates that were previously reported as pan-susceptible using DST. A haplotype consisting of 65 variants was also found among the MTBC isolates with drug-resistance traits., Conclusions: This study is the first effort done in Malaysia to utilize 24 genomes of the local clinical MTBC isolates. The high-resolution molecular epidemiological data obtained provide valuable insights into the mechanistic and epidemiological qualities of TB within the vicinity of Southeast Asia., Competing Interests: None

Introduction: Cognitive dysfunction has been significantly associated with functional impairment in patients with major depressive disorder (MDD)., Methods: This is a subgroup analysis of 211 Malaysian patients recruited from the multicountry, multicenter, cross-sectional Cognitive Dysfunction in Asian patients with Depression (CogDAD) study. Depression severity, cognitive dysfunction, and functional disability were assessed and compared with the overall CogDAD study population. Factors associated with functional disability were also evaluated in this Malaysian patient population., Results: Approximately half of the Malaysian patients were in their first depressive episode, with the majority being treated for mild-to-moderate depression. Furthermore, Malaysian patients experienced cognitive dysfunction, with self-reported Perceived Deficits Questionnaire (PDQ-D) scores falling within the third quartile of PDQ-D severity. Malaysian patients also reported functional disability evidenced by a mean total Sheehan Disability Scale (SDS) score of 11.47 ± 6.68, with the highest SDS score reported in the "Social Life/Leisure Activities" domain. Compared with the overall CogDAD study population, the Malaysian patient population had comparable patient demographics in terms of marital and working status; outcome scores for PHQ-9 (9-item Patient Health Questionnaire for self-reported depression severity), PDQ-D and SDS; and worst perceived cognitive dysfunction reported in the "Attention/Concentration" domain. Factors found to be significantly associated with functional disability were PDQ-D score, sick leave taken, and antidepressant treatment (P < 0.05)., Discussion: Findings from this subgroup analysis highlight the significance of treating cognitive dysfunction in patients with MDD and its correlation to functional disability., (© 2018 John Wiley & Sons Australia, Ltd.)

Objectives: Acceptance and action questionnaire (AAQ II) is a scale used to assess psychological inflexibility. The aim of this study is to translate AAQ II into Malay language and evaluate the psychometric properties of AAQ II Malay version., Methods: The AAQ II which has been translated into Malay language via back translation procedure was distributed to 101 cancer patients and 100 non-cancer patients. The evaluation of psychometric properties in this study included content validity index, internal consistency, parallel reliability, exploratory factor analysis, concurrent validity, sensitivity and specificity of AAQ II Malay version., Results: AAQ II Malay version has established good content validity index, acceptable internal consistency with Cronbach's alpha value of 0.91, excellent parallel reliability and adequate concurrent validity. Exploratory factor analysis (EFA) results demonstrated AAQ II Malay version is a unidimensional factor instrument. The result of sensitivity and specificity of AAQ II Malay version indicated cancer patients who scored more than 17.5 were having significant psychological inflexibility., Conclusion: AAQ II Malay version is a reliable and valid instrument to measure psychological inflexibility among cancer patient in Malaysia., Competing Interests: The authors have declared that no competing interests exist.

Background: The use of alternative and complementary medicines to alleviate stress has increased to avoid the negative effects of pharmaceutical drugs., Objective: This study investigated the safety and efficacy of Eurycoma longifolia in combination with multivitamins (EL+MV) versus placebo on improving quality of life (QoL), mood and stress in moderately stressed healthy participants., Methods: This randomised, double-blind, placebo-controlled 24-week study enrolled 93 participants aged 25-65 years, with a body mass index of 18-30 kg/m 2 , scoring ≤18 in tension and ≤14 in fatigue subscale of Profiles of Mood Scores (POMS) questionnaire and supplemented with EL+MV or placebo. The primary endpoints were QoL measured by 12-Item Short Form Health Survey (SF-12) questionnaire and mood measured by POMS. The secondary endpoint was stress measured by Multi-Modal Stress Questionnaire (MMSQ). The safety of the intervention product was measured by complete metabolic panel, lipid and renal analysis including several immune parameters., Results: While there were no significant between-group differences, within-group improvements were observed in the SF-12 QoL, POMS and MMSQ domains. In the SF-12 domain, improvements were seen in role limitation due to emotional health ( P = 0.05), mental component domain ( P < 0.001), emotional well-being ( P < 0.001), social functioning ( P = 0.002) as well as vitality ( P = 0.001) at week 12. An increasing trend in POMS-vigour domain was also observed in the EL+MV group at week 12. A 15% decrease in physical stress domain ( P < 0.05) compared with 0.7% in the placebo group was also observed in MMSQ. When the subjects were subgrouped according to age, 25-45 and 46-65 years of age, for primary outcomes, between-group significance was observed in the 25-45 year group in the social functioning domain of SF-12 ( P = 0.021) and POMS-vigour ( P = 0.036) in the 46-65 year group. No significant changes were observed in vital signs and complete metabolic panel. Regarding immune parameters, the lymphocytes increased significantly in the active group ( P ≤0.05). In total, 13 adverse events were reported: six on placebo and seven on EL+MV., Conclusion: EL+MV may support the QoL, mood, stress and immune parameters in healthy participants., Trial Registration: This study has been registered at clinicaltrials.gov (NCT02865863)., Competing Interests: The study was funded by NKEA Research Grant Scheme (NRGS) EPP#1 under the Ministry of Agriculture and Agro Based Industry, Malaysia. Annie George is an employee of Biotropics Malaysia Berhad. The authors have no potential conflict of interest.

Purpose of Review: To understand the current situation, needs and challenges in the area of postgraduate training in psychiatry in Asia and identify implementable solutions.Leaders in psychiatric education from nine Asia Pacific countries prepared country reports, based on a suggested list of items and met for a day to discuss and identify implementable solutions to improve the current unsatisfactory status of postgraduate training in psychiatry., Recent Findings: Except Japan, all the other countries have a very low number of psychiatrists per 100 000 population - far lower than the global target of 10 psychiatrist per 100 000 population. The undergraduate teaching in psychiatry in majority of the countries is restricted to 20 h of lectures given during the 4-6 semester and 2-3 weeks of clinical ward placements. The duration as well as the overall quality of postgraduate training and methods of assessment and accreditation varies widely across and within countries., Summary: Numerous gaps that need to be addressed to enhance the quality of psychiatrists trained in Asia were identified. There is a need to have uniform minimum standards of training and mechanisms of mutual support, for not only training but also academics and research activities in Asia.

The use of physical restraint exposes patients and staff to negative effects, including death. Therefore, teaching nursing staff to develop the improve knowledge, skills, and attitudes regarding physical restraint has become necessary. A quasi-experimental pre-post design was used to evaluate the effect of educational intervention on nurses' knowledge, attitude, intention, practice and incidence rate of physical restraint in 12 wards of a hospital using a self-reported questionnaire and a restraint order form in Malaysia. The educational intervention, which included a one-day session on minimising physical restraint use in hospital, was presented to 245 nurses. The results showed a significant increase in the mean knowledge, attitude sand practice score and a significant decrease in the mean intention score of nurses to use physical restraint after intervention. There was a statistically significant decrease in the incidence rate of physical restraint use in the wards of the hospital except geriatric-rehabilitation wards after intervention., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Several studies have described the presence of perceived cognitive dysfunction amongst Asian patients with major depressive disorder (MDD). To date, no study has been conducted investigating the predictors of perceived cognitive dysfunction amongst Asian MDD patients., Methods: This was a post-hoc analysis of the Cognitive Dysfunction in Asian patients with Depression (CogDAD) study. Descriptive statistics were used to describe the most common cognitive complaints by patients. Univariate and multivariate analyses were performed to determine variables associated with perceived cognitive dysfunction (Perceived Deficit Questionnaire-Depression, PDQ-D)., Results: The CogDAD study population is comprised of MDD patients with mild-to-moderate depression (Patient Health Questionnaire 9-item [PHQ-9]: 11.3 ± 6.9) who reported perceived cognitive dysfunction (PDQ-D = 22.6 ± 16.2). The most common cognitive complaints were: mind drifting (42.3%), trouble making decision (39.6%) and trouble concentrating (38.0%). Predictors of perceived cognitive dysfunction were: being Southeast Asians (vs. Taiwanese) (p < 0.001), current episode longer than 8 weeks (vs. 1-8 weeks) (p < 0.05), the presence of disability (vs. no disability) (p < 0.05), younger age (p < 0.01), and higher PHQ-9 total scores (p < 0.001)., Limitations: The causal relationship between predictive variables and PDQ-D could not be tested due to the cross-sectional nature of the study. Furthermore, a neuropsychological test was not included in the CogDAD study and use of concomitant medications, including anti-depressants, could have impacted patient's perceived cognitive ability., Conclusions: The present study results suggest a potential role for subjective cognitive assessment in patients with MDD who are young, with long durations of depression or severe depression., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Incidence rate and patterns of physical restraint use were examined based on a cross-sectional study in 22 wards of a large teaching hospital in Malaysia. Results indicated that the highest rate of physical restraint (19.7%) was reported from neurology-neurosurgery wards. "Un-cooperative for electroconvulsive therapy" and "trying to pull out catheters" were the most commonly reported reasons to use restraint in psychiatric and non-psychiatric wards, respectively. There were some relationships between patterns of physical restraint in this study. Exploring the incidence rate and patterns of physical restraint is important so that effective strategies can be formulated to minimize using restraint in hospitals.

This study evaluates the in vitro inhibition of angiotensin-converting enzyme (ACE) and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA) by Pleurotus pulmonarius extracts. The protective effect on the endothelial membrane against oxidative stress through the protection of nitric oxide bioavailability, as well as inhibition of endocan expression, was evaluated using human aortic endothelial cells (HAECs). Crude cold aqueous extract exhibited the most potent inhibitory activities against ACE and HMG-CoA reductase, with 61.79% and 44.30% inhibition, respectively. It also protected the bioavailability of NO released by HAECs, with 84.88% cell viability. The crude hot water extract was the most potent in inhibiting endocan expression, with 18.61% inhibition.

Cancer patients are commonly associated with various physical and psychological symptoms. In palliative setting, the aims are to relieve those symptoms, improve quality of life, and increase medication adherence among cancer patients. Antidepressants are generally accepted for the treatment of depression among patients with or without cancer. Some other potential benefits of the antidepressants have been reported in cancer patients., Objective: This study aims to review the use of antidepressants for physical and psychological symptoms in cancer patients., Results: Our findings showed the mixed result of positive and negative findings in various symptoms associated with cancer patients. These studies are categorised according to the hierarchy of evidence from high to low level, namely randomised controlled trials, cohort studies, case-control studies, case series, case reports, as well as other type of publications. The majority of antidepressants used in cancer patients seem to be beneficial for the treatment of depression, anxiety, hot flashes and other symptoms such as sexual dysfunction, fatigue, nicotine dependence, vasomotor symptoms, executive functions, sleep problems, pruritus, as well as for hypochondriasis. While fluoxetine was found to be associated with the reduction of antiemetic property in ondansetron, mirtazapine was identified to be a good alternative in treating nausea and cachexia among cancer patients., Conclusion: More research studies with adequate statistical power are warranted to validate the use of antidepressants among cancer patients in treating these physical and psychological symptoms., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Aims and Objectives: To investigate the knowledge, attitude, intention and practice of nurses towards physical restraint and factors influencing these variables., Background: A literature review showed a lack of studies focused on the intention of nurses regarding physical restraint throughout the world. Considering that very little research on physical restraint use has been carried out in Malaysia, assessment of nurses' knowledge, attitude, intention and practice is necessary before developing a minimising programme in hospitals., Design: A cross-sectional study was used., Methods: A questionnaire to assess the knowledge, attitude, intention and practice was completed by all nurses (n = 309) in twelve wards of a teaching hospital in Kuala Lumpur., Results: Moderate knowledge and attitude with strong intention to use physical restraint were found among the nurses. Less than half of nurses considered alternatives to physical restraint and most of them did not understand the reasons for the physical restraint. Nurses' academic qualification, read any information source during past year and nurses' work unit showed a significant association with nurses' knowledge. Multiple linear regression analysis found knowledge, attitude and intention were significantly associated with nurses' practice to use physical restraint., Conclusion: This study showed some important misunderstandings of nurses about using physical restraint and strong intention regarding using physical restraint. Findings of this study serve as a supporting reason for importance of educating nurses about the use of physical restraint., Relevance to Clinical Practice: Exploring the knowledge, attitude, intention and current practice of nurses towards physical restraint is important so that an effective strategy can be formulated to minimise the use of physical restraints in hospitals., (© 2017 John Wiley & Sons Ltd.)

Alleviation of suffering in palliative care needs a combination of good symptom control and psychosocial care. The capacity of mindfulness to promote psychological flexibility opens up possibilities of creating a paradigm shift that can potentially change the landscape of psychosocial care. In this review, we attempt to introduce 4 methods to establish mindfulness based on 'The Discourse on the Foundations of Mindfulness', a core text of Theravada Buddhism, followed by a brief comparison of the concepts and practices of mindfulness in different cultures and religions in Southeast Asia. Next, 2 mindfulness-based interventions specifically designed for palliative psychosocial care - mindfulness-based supportive therapy (MBST) and mini-mindfulness meditation (MMM) are introduced. We hypothesise that mindful practices, tailored to the palliative setting, can promote positive psychosocial outcomes.

There is a lack of studies looking into religiosity and religious coping in cancer patient. In this cross-sectional study, we examined the religiosity using Duke University Religion Index, religious coping using Brief Religious Coping Scale, anxiety and depression based on Hospital Anxiety and Depression Scale among 200 cancer patients. The association between religiosity and religious coping with anxiety and depression was studied. The findings showed that subjects with anxiety or depression used more negative religious coping and had lower non-organization religiosity. Hence, measurements in reducing negative religious coping and encouraging religious activities could help to reduce psychological distress in cancer patients.

Background: Breast cancer patients often experience a high level of distress. Psychological distress is a broad construct encompass both depression and anxiety. Previous studies in examining which of these psychological symptoms (either anxiety or depression) were more significantly associated with the distress level in breast cancer patients is lacking. This study aims to compare the level of depression and anxiety between patients with different level of distress. The correlation between the changes in distress level with depression or anxiety over 12 months was also examined., Methods: This study is from the MyBCC cohort study. Two hundred and twenty one female breast cancer patients were included into the study. They were assessed at the time of diagnosis, 6 months and 12 month using Hospital Anxiety and Depression Scale (HADS) and distress thermometer. The information on age, ethnicity, treatment types and staging of cancer were collected., Results: 50.2%, 51.6% and 40.3% of patients had perceived high level of distress at baseline, 6 months and 1 year after diagnosis. Those with high perceived level of distress had significant higher anxiety scores even after adjusted for the underlying depressive scores (Adjusted OR at baseline = 1.28, 95% CI = 1.13-1.44; adjusted OR at 6 months = 1.27, 95% CI = 1.11-1.45; adjusted OR at 12 months = 1.51, 95% CI = 1.29-1.76). There were no significant differences in the depressive scores between the subjects with either low or high distress level. There was reduction in perceived level of distress, anxiety and depression scores at 12 months after the diagnosis. The decrease of distress was positively correlated with the reduction of anxiety scores but not the changes of depressive scores (r' = 0.25)., Conclusion: Anxiety is a more significant psychological state that contributed to the feeling of distress in breast cancer as compared with depression. Levels of anxiety at diagnosis in this study would justify screening for anxiety, early identification and therapy for maintaining the psychological well-being of breast cancer patients. Further studies will be needed to measure the effectiveness of therapeutic interventions.

Introduction: The occurrence of female sexual dysfunction (FSD) in patients with major depressive disorder (MDD) receiving selective serotonin reuptake inhibitors (SSRIs) treatment gives negative impacts on patients' quality of life and causes treatment discontinuation. We aimed to investigate whether genetic polymorphism of identified candidate gene is associated with FSD in our study population., Methods: This is a cross-sectional study. A total of 95 female patients with MDD who met the criteria of the study were recruited and were specifically assessed on the sexual function by trained psychiatrists. Patients' DNA was genotyped for BDNF Val66Met polymorphism using real-time polymerase chain reaction., Results: The prevalence of FSD in this study is 31.6%. In the FSD group, patients with problematic marriage were significantly more frequent compared with patients who did not have problematic marriage (P = 0.009). Significant association was detected in the lubrication domain with BDNF Val66Met polymorphism (P = 0.030) using additive genetic model, with even stronger association when using the recessive model (P = 0.013)., Discussion: This study suggested that there was no significant association between BDNF Val66Met with FSD. However, this polymorphism is significantly associated with lubrication disorder in patients treated with SSRIs., (© 2015 Wiley Publishing Asia Pty Ltd.)

Background: Palliative cancer patients suffer from high levels of distress. There are physiological changes in relation to the level of perceived distress., Objective: To study the efficacy of 5 minutes of mindful breathing (MB) for rapid reduction of distress in a palliative setting. Its effect to the physiological changes of the palliative cancer patients was also examined., Methods: This is a randomized controlled trial. Sixty palliative cancer patients were recruited. They were randomly assigned to either 5 minutes of MB or normal listening arms. The changes of perceived distress, blood pressure, pulse rate, breathing rate, galvanic skin response, and skin surface temperature of the patients were measured at baseline, after intervention, and 10 minutes post-intervention., Results: There was significant reduction of perceived distress, blood pressure, pulse rate, breathing rate, and galvanic skin response; also, significant increment of skin surface temperature in the 5-minute MB group. The changes in the 5-minute breathing group were significantly higher than the normal listening group., Conclusion: Five-minute MB is a quick, easy to administer, and effective therapy for rapid reduction of distress in palliative setting. There is a need for future study to establish the long-term efficacy of the therapy.

Although major progress has been achieved in research and development of antipsychotic medications for bipolar disorder (BPD), knowledge of the molecular mechanisms underlying this disorder and the action of atypical antipsychotics remains incomplete. The levels of microRNAs (miRNAs)-small non-coding RNA molecules that regulate gene expression, including genes involved in neuronal function and plasticity-are frequently altered in psychiatric disorders. This study aimed to examine changes in miRNA expression in bipolar mania patients after treatment with asenapine and risperidone. Using a miRNA microarray, we analyzed miRNA expression in the blood of 10 bipolar mania patients following 12 weeks of treatment with asenapine or risperidone. Selected miRNAs were validated by using real-time PCR. A total of 16 miRNAs were differentially expressed after treatment in the asenapine group, 14 of which were significantly upregulated and the other two significantly downregulated. However, all three differentially expressed miRNAs in the risperidone group were downregulated. MiRNA target gene prediction and gene ontology analysis revealed significant enrichment for pathways associated with immune system response and regulation of programmed cell death and transcription. Our results suggest that candidate miRNAs may be involved in the mechanism of action of both antipsychotics in bipolar mania. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objective Psychotherapy is a common non-pharmacological approach to help cancer patients in their psychological distress. The benefit of psychotherapies was documented, but the types of psychotherapies proposed are varied. Given that the previous literature review was a decade ago and no quantitative analysis was done on this topic, we again critically and systematically reviewed all published trials on psychotherapy in cancer patients. Method We identified 17 clinical trials on six types of psychotherapy for cancer patients by searching PubMed and EMBASE. Result There were four trials involved adjunct psychological therapy which were included in quantitative analysis. Each trial demonstrated that psychotherapy improved the quality of life and coping in cancer patients. There was also a reduction in distress, anxiety, and depression after a psychological intervention. However, the number and quality of clinical trials for each type of psychotherapy were poor. The meta-analysis of the four trials involved adjunct psychological therapy showed no significant change in depression, with only significant short-term improvement in anxiety but not up to a year-the standardized mean differences were -0.37 (95% confidence interval (CI) = -0.57, -0.16) at 2 months, -0.21 (95% CI = -0.42, -0.01) at 4 months, and 0.03 (95 % CI = -0.19, 0.24) at 12 months. Conclusion The evidence on the efficacy of psychotherapy in cancer patients is unsatisfactory. There is a need for more rigorous and well-designed clinical trials on this topic.

A pilot study was conducted to evaluate the efficacy of 5-minute mindful breathing in distress reduction. Twenty palliative care patients and family caregivers with a distress score ≥4 measured by the Distress Thermometer were recruited and randomly assigned to mindful breathing or "listening" (being listened to). Median distress reductions after 5 minutes were 2.5 for the mindful breathing group and 1.0 for the listening group. A significantly larger reduction in the distress score was observed in the mindful breathing group (Mann-Whitney U test: U = 8.0, n1 = n2 = 10, mean rank1 = 6.30, mean rank2 = 14.70, z = -3.208, P = .001). The 5-minute mindful breathing could be useful in distress reduction in palliative care., (© The Author(s) 2015.)

This study evaluated the in vitro antioxidant capacities of extracts from Pleurotus pulmonarius via Folin-Ciocalteu, 1,1-diphenyl-2-picrylhydrazyl free radical scavenging, metal chelating, cupric ion reducing antioxidant capacity, and lipid peroxidation inhibition assays. Extract compositions were determined by phenol-sulfuric acid; Coomassie Plus (Bradford) protein; Spectroquant zinc, copper, and manganese test assays; and liquid chromatography-tandem mass spectrometry (LC/MS/MS) and gas chromatography-mass spectrometry (GC/MS). Methanol-dichloromethane extract, water fraction, hot water, aqueous extract and hexane fraction exhibited the most potent extracts in the antioxidant activities. LC/MS/MS and GC/MS showed that the extracts contained ergothioneine, ergosterol, flavonoid, and phenolic compounds. The selected potent extracts were evaluated for their inhibitory effect against oxidation of human low-density lipoproteins and protective effects against hydrogen peroxide-induced cytotoxic injury in human aortic endothelial cells. The crude aqueous extract was deemed most potent for the prevention of human low-density lipoprotein oxidation and endothelial membrane damage. Ergothioneine might be the compound responsible for the activities, as supported by previous reports. Thus, P. pulmonarius may be a valuable antioxidant ingredient in functional foods or nutraceuticals.

Background: Depression and anxiety are common psychiatric morbidity among breast cancer patient. There is a lack of study examining the correlation between depression, anxiety and quality of life (QoL) with perceived social support (PSS) among breast cancer patients. This study aims to study the level of depression, anxiety, QoL and PSS among Malaysian breast cancer women over a period of 12 months and their associations at baseline, 6 and 12 months., Methods: It is a 12 months prospective cohort study. Two hundred and twenty one female patients were included in the study. They were assessed at the time of diagnosis, 6 months and 12 month using Hospital Anxiety and Depression Scale (HADS), Quality-of-Life Questionnaire (QLQ-C30), Version 3.0 of the EORTC Study Group and Multidimensional Scale of Perceived Social Support (MSPSS). The information of age, ethnicity, types of treatment, and staging of cancer were collected., Results: The HADS anxiety and depression subscales scores of the subjects were relatively low. The level of anxiety reduced significantly at 6 and 12 months (Baseline - 6 months, p = 0.002; Baseline - 12 months, p < 0.001). There were no changes in the level of depression over the study period. The global status of QoL and MSPSS scores were relatively high. Correlation between the global status of QoL and MSPSS for the study subjects was positive (Spearman's rho = 0.31-0.36). Global status of QoL and MSPSS scores were negatively correlated with anxiety and depression., Conclusion: Malaysian breast cancer women had relatively better QoL with lower level of anxiety and depression. Perceived social support was an important factor for better QoL and low level of psychological distress. It reflects the importance of attention on activities that enhance and maintain the social support system for breast cancer patients.

The Hospital Anxiety and Depression Scale (HADS) is a common screening instrument used to determine the levels of anxiety and depression experienced by a patient and has been extensively used in patients with coronary artery disease (CAD). This study aimed to establish the factor structure of HADS in a Malaysian sample of 189 patients with CAD. Factor analysis of HADS using principal component analysis with varimax rotation yielded 3 factors. Confirmatory factor analysis supported the use of HADS in assessing 3 distinct dimensions of psychological distress--namely, anxiety, anhedonia, and psychomotor retardation. The HADS showed good internal consistency and was found to be a valid measure of psychological distress among Malaysian patients with CAD. However, low mean scores on the original 2 factors--that is, anxiety and depression--and also on the 2 depression subscales--anhedonia and psychomotor retardation--suggests that the recommended cutoff score to screen for psychological distress among CAD patients be reevaluated. Further research to determine the generalizability and consistency for the tridimensional structure of the HADS in Malaysia is recommended., (© 2014 APJPH.)

Introduction: Numerous association studies of candidate genes studies with major depressive disorder (MDD) have been conducted for many years; however, the evidence of association between genes and the risk of developing MDD still remains inconclusive. In this study, we aimed to investigate the association between the tryptophan hydroxylase 2 (TPH2) gene and MDD in three ethnic groups (Malay, Chinese and Indian) within the Malaysian population., Methods: Two hundred and sixty five MDD patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for MDD and 332 healthy controls were recruited for the study. All cases and controls were then genotyped for TPH2 polymorphisms rs1386494, rs1386495 and rs7305115., Results: Single locus analysis in pooled and ethnically stratified subjects revealed no association between each of the three variants of the TPH2 gene with susceptibility to MDD. Strong linkage disequilibrium was detected between rs1386495 and rs1386494 in pooled subjects; however, no significant association was found in the haplotype analysis., Discussions: In this study, we suggest that in both the Chinese and Indian populations, gender distribution differ significantly between cases and controls, showing that women are more at risk of developing MDD compared with men. Therefore, we suggest that the occurrence of MDD in both Chinese and Indians in the Malaysian population may be influenced by gender., (Copyright © 2013 Wiley Publishing Asia Pty Ltd.)

Poor eating behavior has been identified as one of the core contributory factors of the childhood obesity epidemic. The consequences of obesity on numerous aspects of life are thoroughly explored in the existing literature. For instance, evidence shows that obesity is linked to incidences of diseases such as heart disease, type-2 diabetes, and some cancers, as well as psychosocial problems. To respond to the increasing trends in the UK, in 2008 the government set a target to reverse the prevalence of obesity (POB) back to 2000 levels by 2020. This paper will outline the application of system dynamics (SD) optimization to simulate the effect of changes in the eating behavior of British children (aged 2 to 15 years) on weight and obesity. This study also will identify how long it will take to achieve the government's target. This paper proposed a simulation model called Intervention Childhood Obesity Dynamics (ICOD) by focusing the interrelations between various strands of knowledge in one complex human weight regulation system. The model offers distinct insights into the dynamics by capturing the complex interdependencies from the causal loop and feedback structure, with the intention to better understand how eating behaviors influence children's weight, body mass index (BMI), and POB measurement. This study proposed a set of equations that are revised from the original (baseline) equations. The new functions are constructed using a RAMP function of linear decrement in portion size and number of meal variables from 2013 until 2020 in order to achieve the 2020 desired target. Findings from the optimization analysis revealed that the 2020 target won't be achieved until 2026 at the earliest, six years late. Thus, the model suggested that a longer period may be needed to significantly reduce obesity in this population.

Thalassaemia carriers are common in the Asian region including Malaysia. Asymptomatic patients can be undiagnosed until they present for their antenatal visits. Devastating obstetric outcome may further complicate the pregnancy if both parents are thalassaemia carriers leading to hydrophic fetus due to haemoglobin Bart's disease. However in certain cases where unexplained hydrops fetalis occur in parents with heterozygous thalassaemia carrier,mutated α genes should be suspected. We report a twenty-nine year old woman in her third pregnancy with two previous pregnancies complicated by early neonatal death at 21 and 28 weeks of gestation due to hydrops fetalis. DNA analysis revealed the patient to have heterozygous (--SEA) α-gene deletion, while her husband has a compound heterozygosity for α(3.7) deletion and codon 59 (GGC → GAC) mutation of the α-gene. This mutation, also known as hemoglobin Adana, can explain hydrops fetalis resulting from two alpha gene deletions from the patient (mother) and a single alpha gene deletion with mutation from the father. The third pregnancy resulted in a grossly normal baby boy with 3 α-gene deletions (HbH disease). We postulate that, in view of heterogenisity of the α-thalassaemia in this patient with severely unstable haemoglobin Adana chains from her husband, there will be a 25% possibility of fetal hydrops in every pregnancy.

Introduction: Liver transplant candidates are vulnerable to develop depression. This paper aims to ascertain the prevalence of depression in liver transplant candidates and its psychosocial factors in a systematic review., Methods: An extensive review via electronic databases (PubMed, EMBASE, CINAHL) and hand search were carried out to retrieve published articles up to December 15, 2013, using (Incidence OR Prevalence) AND Depress* AND liver transplant as the keywords. Information on the study design, patient characteristics, prevalence of depression, and its associated risk factors were extracted from included studies., Results: There were 22 studies included in this review with a total of 3055 patients. The prevalence of depression in the liver transplant candidates ranges between 2% and 80%. Studies that used diagnostic tools found a narrower range of prevalence (4.5-43%) as compared to the self-administered questionnaires (2-80%). Studies that used Beck Depression Inventory reported a higher prevalence than those studies which used Hospital Anxiety and Depression Scale (median = 28%, range = 2-80% versus median 17%, range 6.1-25.8%). A number of socio-demographic factors, illness-related and psychosocial factors were found to be associated with depression., Conclusion: Prevalence of depression in liver transplant candidates is high, and early detection will improve survival and quality of life., (© 2014 Wiley Publishing Asia Pty Ltd.)

The polysaccharide fraction from Solanum nigrum Linne has been shown to have antitumor activity by enhancing the CD4+/CD8+ ratio of the T-lymphocyte subpopulation. In this study, we analyzed a polysaccharide extract of S. nigrum to determine its modulating effects on RAW 264.7 murine macrophage cells since macrophages play a key role in inducing both innate and adaptive immune responses. Crude polysaccharide was extracted from the stem of S. nigrum and subjected to ion-exchange chromatography to partially purify the extract. Five polysaccharide fractions were then subjected to a cytotoxicity assay and a nitric oxide production assay. To further analyze the ability of the fractionated polysaccharide extract to activate macrophages, the phagocytosis activity and cytokine production were also measured. The polysaccharide fractions were not cytotoxic, but all of the fractions induced nitric oxide in RAW 264.7 cells. Of the five fractions tested, SN-ppF3 was the least toxic and also induced the greatest amount of nitric oxide, which was comparable to the inducible nitric oxide synthase expression detected in the cell lysate. This fraction also significantly induced phagocytosis activity and stimulated the production of tumor necrosis factor-α and interleukin-6. Our study showed that fraction SN-ppF3 could classically activate macrophages. Macrophage induction may be the manner in which polysaccharides from S. nigrum are able to prevent tumor growth.

Recent studies have shown that bipolar disorder (BPD) and schizophrenia (SZ) share some common genetic risk factors. This study aimed to examine the association between candidate single nucleotide polymorphisms (SNPs) identified from genome-wide association studies (GWAS) and risk of BPD and SZ. A total of 715 patients (244 BPD and 471 SZ) and 593 controls were genotyped using the Sequenom MassARRAY platform. We showed a positive association between LMAN2L (rs6746896) and risk of both BPD and SZ in a pooled population (P-value=0.001 and 0.009, respectively). Following stratification by ethnicity, variants of the ANK3 gene (rs1938516 and rs10994336) were found to be associated with BPD in Malays (P-value=0.001 and 0.006, respectively). Furthermore, an association exists between another variant of LMAN2L (rs2271893) and SZ in the Malay and Indian ethnic groups (P-value=0.003 and 0.002, respectively). Gene-gene interaction analysis revealed a significant interaction between the ANK3 and LMAN2L genes (empirical P=0.0107). Significant differences were shown between patients and controls for two haplotype frequencies of LMAN2L: GA (P=0.015 and P=0.010, for BPD and SZ, respectively) and GG (P=0.013 for BPD). Our study showed a significant association between LMAN2L and risk of both BPD and SZ., (Copyright © 2014 Elsevier Inc. All rights reserved.)

This is a 4 week, randomized, double-blind, placebo-controlled study to examine the effects of methylphenidate as add-on therapy to mirtazapine compared to placebo for treatment of depression in terminally ill cancer patients. It involved 88 terminally ill cancer patients from University of Malaya Medical Centre, Kuala Lumpur, Malaysia. They were randomized and treated with either methylphenidate or placebo as add on to mirtazapine. The change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to day 3 was analyzed by linear regression. Changes of MADRS and Clinical Global Impression-Severity Scale (CGI-S) over 28 days were analyzed using mixed model repeated measures (MMRM). Secondary analysis of MADRS response rates, defined as 50% or more reduction from baseline score. A significantly larger reduction of Montgomery-Åsberg Depression Rating Scale (MADRS) score in the methylphenidate group was observed from day 3 (B=4.14; 95% CI=1.83-6.45). Response rate (defined as 50% or more reduction from baseline MADRS score) in the methylphenidate treated group was superior from day 14. Improvement in Clinical Global Impression-Severity Scale (CGI-S) was greater in the methylphenidate treated group from day 3 until day 28. The drop-out rates were 52.3% in the methylphenidate group and 59.1% in the placebo group (relative risk=0.86, 95%CI=0.54-1.37) due to cancer progression. Nervous system adverse events were more common in methylphenidate treated subjects (20.5% vs 9.1%, p=0.13). In conclusions, methylphenidate as add on therapy to mirtazapine demonstrated an earlier antidepressant response in terminally ill cancer patients, although at an increased risk of the nervous system side effects., (Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.)

Aim: The occurrence of metabolic syndrome (MS) in schizophrenia patients receiving long-term antipsychotics (APs) contributes to their high mortality rate. We aimed to determine whether genetic polymorphisms of identified candidate genes are associated with MS in our study population., Materials & Methods: We recruited 206 schizophrenia patients receiving AP treatment for at least a year. Cross-sectional measurements of weight, height, blood pressure, waist and hip circumference, and other lipid profiles were recorded. Patient DNA was genotyped for 16 candidate gene polymorphisms., Results: Of these patients, 59.7% were found to have MS while 40.3% did not. All metabolic parameters were significantly different between the two groups. Only three of the 16 polymorphisms studied showed significant association with MS; rs9939609 of the FTO gene confers risk for MS (odds ratio [OR]: 1.73, 95% CI: 1.07-2.78, p = 0.026), while rs1137101 of the LEPR gene (OR: 0.47, 95% CI: 0.28-0.80, p = 0.005) and rs1801133 of the MTHFR gene (OR: 0.59, 95% CI: 0.35-0.99, p = 0.049) are protective against MS., Conclusion: Polymorphisms of the FTO, LEPR and MTHFR genes may play a role in MS in Malaysian schizophrenia patients receiving long-term treatment with APs.

Objectives: Various genetic polymorphisms have been reported to be associated with antipsychotic-induced weight gain. In this study, we aimed to determine whether risk polymorphisms in 12 candidate genes are associated with reduction in body mass index (BMI) of patients following switching of antipsychotics to aripiprazole or ziprasidone., Methods: We recruited 115 schizophrenia patients with metabolic abnormalities and who have been on at least 1 year treatment with other antipsychotics; they were then switched to either aripiprazole or ziprasidone. They were genotyped, and their BMI monitored for 6 months., Results: Significant associations with reduction in BMI at 6 months following switching were found in two of these genes: with rs1800544 of the ADRA2A gene (CC + CG [-0.32 ± 1.41 kg/m²] vs GG [-1.04 ± 1.63 kg/m²], p = 0.013) and with rs1801131 of the MTHFR gene (AA [-0.36 ± 1.53] vs AC + CC [-1.07 ± 1.53], p = 0.015)., Conclusion: The study data indicated that carriage of the ADRA2A rs1800544 GG genotype and the MTHFR rs1801131 C allele are associated with BMI reduction in this population following switching of antipsychotics to aripiprazole and ziprasidone., (Copyright © 2013 John Wiley & Sons, Ltd.)

Objective: To examine the prescription rates in cancer patients of three common psychotropic drugs: anxiolytic/ hypnotic, antidepressant and antipsychotic., Materials and Methods: In this retrospective cohort study, data were extracted from the pharmacy database of University Malaya Medical Center (UMMC) responsible for dispensing records of patients stored in the pharmacy's Medication Management and Use System (Ascribe). We analyzed the use of psychotropics in patients from the oncology ward and cardiology from 2008 to 2012. Odds ratios (ORs) were adjusted for age, gender and ethnicity., Results: A total of 3,345 oncology patients and 8,980 cardiology patients were included. Oncology patients were significantly more often prescribed psychotropic drugs (adjusted OR: anxiolytic/hypnotic=5.55 (CI: 4.64-6.63); antidepressants=6.08 (CI: 4.83-7.64) and antipsychotics=5.41 (CI: 4.17-7.02). Non-Malay female cancer patients were at significantly higher risk of anxiolytic/hypnotic use., Conclusions: Psychotropic drugs prescription is common in cancer patients. Anxiolytic/hypnotic prescription rates are significantly higher in non-Malay female patients in Malaysia.

Two single nucleotide polymorphisms of PDLIM5, rs7690296 and rs11097431, were genotyped using Mass-Array SNP genotyping by Sequenom technology in 244 bipolar disorder patients, 471 schizophrenia patients, and 601 control individuals who were Malay, Chinese, and Indian ethnic groups in the Malaysian population. A significant association was observed in allele frequency between the rs7690296 polymorphism and bipolar disorder in the Indian ethnic group [P=0.02, adjusted odds ratio (OR) 0.058, 95% confidence interval (CI) 0.36-0.93]. A significant association was also observed between the rs7690296 polymorphism and schizophrenia under the recessive model for both Malay (P=0.02, adjusted OR 1.86, 95% CI 1.12-3.10) and Indian (P=0.02, adjusted OR 1.92, 95% CI 1.10-3.37) ethnic groups. However, no association was detected between the rs11097431 polymorphism either with bipolar disorder or with schizophrenia. Therefore, it can be deduced that the nonsynonymous rs7690296 polymorphism could play an important role in the pathophysiology of both bipolar disorder and schizophrenia.