IIUM Medical Journal Malaysia

Vaping as a Harm Reduction Strategy: Lessons from the Past

Prof. Dr. Jamalludin Ab Rahman — Tue, 01 Oct 2024 00:00:00 +0800

Loneliness Among the Elderly in Malaysia: A Burgeoning Problem

Prof. Dr. Mohd. Aznan Md. Aris — Tue, 01 Oct 2024 00:00:00 +0800

Outcome of Negative Computed Tomographic Angiography in the Management of Gastrointestinal Bleeding at a Tertiary Centre: A Cross-sectional Study

Mohamad Izzat Arslan Che Ros, Nur Yazmin Yaacob, Nurafiqah Farhana Muhd Yazid — Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Acute gastrointestinal bleeding is a common gastrointestinal emergency. Only limited studies are available regarding the clinical outcomes after computed tomographic angiography (CTA) mesentery showed negative for active bleed. This study aims to determine the clinical outcome of negative mesentery CTA in patients with clinically active acute gastrointestinal (GI) bleeding. MATERIAL AND METHODS: A cross-sectional study with a universal sampling method was used. Patients who underwent CTA to detect gastrointestinal bleeding in the National University Hospital of Malaysia from December 2015 until March 2021 were retrospectively analysed. The outcome of each patient, risk of re-bleeding, and 30-days mortality rate were evaluated and assessed. RESULTS: In total, 280 CTAs were performed on 232 patients, with 186 of them showing negative results on their first initial CTA. 40.8% (76/186) of those with negative initial CTA had recurrent bleeding and 73.6% (56/76) of them required active intervention. We found that the risk of re-bleeding is lower in the upper gastrointestinal group compared to the lower gastrointestinal group (OR=1.5, 95% CI: 0.877- 2.852, p: 0.128). The overall 30 days mortality rate after the first negative CTA was 23.1% (43/186). Among those patients who experienced re-bleeding, 32.8% (25/76) died within 30 days, with 18.4% (14/76) succumbing to massive bleeding. CONCLUSION: From our analysis, it can be concluded that a clinically active GI bleeding with negative mesentery CTA has a 40.8% chance to re-bleed with 23.1% 30-day mortality rate. Close observation and follow-up

ECG Risk Score Model to Predict SCD in HFrEF: Retrospective Review in a Tertiary Centre

Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Heart failure with reduced ejection fraction (HFrEF) patients need to be risk stratify as guidelines have shown that patients with left ventricularejection fraction (LVEF) <35% could be prevented from sudden cardiac death (SCD) by insertion of prophylactic implantable cardioverter-defibrillator (ICD). Thus we conducted a retrospective single tertiary centre study to evaluate the used of electrocardiogram (ECG) risk score model in identifying the individuals who at higher risk of SCD. MATERIALS AND METHODS: A total of 356 heart failure with reduced ejection fraction (HFrEF) patients treated at University Malaya Medical Centre between January 2017 and December 2021 were enrolled into this study. The patients’ demographics, types of heart failure, medications, and ECG parameters data were collected. The study outcomes were survivor or death in and the cause of death were subdivided into SCD or non-sudden cardiac death (non-SCD). RESULTS: A total of 156 study patients were survivor whereas another 120 had SCD and 70 had non-SCD. There were six ECG parameters that remained significant in the final model, namely the bundle branch block (BBB), abnormal P waves, QRS duration, QTc duration, TpTe interval and PR interval. The significant ECG parameters were combined into a risk score to enumerate prediction ability towards SCD. From our ECG risk score model, subject with ≥2 ECG abnormalities had more than 3-fold increased risk for SCD (HR 3.739, 95% CI 1.703-8.211, P 0.001) and the risk proportionately increased with increasing ECG abnormalities. CONCLUSION: Our findings suggested that the cumulative ECG risk score model was independently associated with SCD and particularly effective for LVEF <40% where risk stratification model remained scarce. So, we would like to propose for a prospective study to further evaluate our study outcome.

The Management Outcome of Heart Failure Reduced Ejection Fraction with or without Angiotensin Receptor Neprilysin Inhibitor

Jin Teng Wu, Ayman Sirelkhatim Ali Suliman, Wan Yus Haniff Wan Isa — Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Heart failure is associated with recurrent admission, higher mortality and low quality of life. Angiotensin receptor neprilysin inhibitor (ARNI) is a novel agent that has been used for treating heart failure reduced ejection fraction (HFrEF) patients. Thus, it is interesting to evaluate the effect of ARNI on the reverse cardiac remodelling, rehospitalization, cardiac biomarker and quality of life in HFrEF patients. MATERIALS AND METHODS: A case controlled study was conducted to assess the treatment outcome of HFrEF with or without ARNI. During the study, the patients’ basic demography, co-morbidities, baseline echocardiography (ECHO) findings, NYHA classification, NT-pro BNP levels and KCCQ score were evaluated. The patients’ admission history within 90 days from initiation of ARNI or non ARNI were obtained retrospectively. A follow up ECHO was obtained after at least 3 months of intervention. RESULTS: A total of 81 patients were recruited in which 54 patients were on ARNI and 27 were on non ARNI treatment. There was a statistically significant improvement of ejection fraction, left ventricular internal diameter end diastole and systole, and left ventricular end-systolic volume in ARNI group. The NYHA class was also noted to improve after ARNI treatment. The NT-proBNP value was lower whereas the KCCQ score was higher in ARNI group compared to non ARNI group. CONCLUSION: HFrEF patients with ARNI treatment had better reverse cardiac remodelling effect, cardiac biomarker and quality of life compared to non ARNI treatment. Furthermore, patient received ARNI demonstrated improved heart failure classification after treatment

Parental Experience on Female Circumcision in East Coast of Malaysia

Nailil Hanani Suhaimi, Rosnani Zakaria, Rosediani Muhamad, Maryam Mohd Zulkifli — Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Female circumcision (FC) is a deep-rooted tradition in Malaysia, influenced by religious, cultural, and health beliefs. However, it has drawn criticism for its similarities to Female Genital Mutilation (FGM) in Africa, particularly during the 2018 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) by the United Nations Human Rights (UNHR). Amidst this backdrop, this study aimed to investigate parents' perspectives and experiences concerning female circumcision, as well as the factors driving its persistence. MATERIALS AND METHODS: This qualitative study used phenomenological approach and 20 in-depth interviews were conducted using a semi-structured questionnaire until data saturation were reached. We employed convenience and snowball sampling methods. The interviews were recorded, transcribed, and analyzed using NVivo 12 software. We used thematic analysis to identify key themes in the data. RESULTS: Three themes emerged from the interviews: (1) FC is a ‘fitrah’, (2) maintaining good health is the main influence; and (3) FC causing no harm. The main influences on this practice are religious, cultural, and health factors. Parents described the procedure as simple and harmless for the baby and themselves, both physically and emotionally. CONCLUSIONS: This research shown that FC in Malaysia is not solely religious but deeply embedded in culture. The blend of cultural and religious aspects makes it a crucial practice for some.

The Effects of Psychological First Aid Training on Knowledge, Perceived Ability Using the Skill, and Quality of Life among Medical Students

Chuong Hock Ting, Yoke Yong Chen , Siok Ping Voon, Md Mizanur Rahman — Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: The response to the crisis in Malaysia in recent years has led to a growing need for mental health services and a general dependence on mental health professionals to address the issue. It is widely acknowledged that providing psychological first aid (PFA) to survivors in the immediate aftermath of a crisis or disaster is an effective first step toward meeting their psychosocial needs. This study aims to determine the impact of PFA training on medical students’ knowledge, perceived ability to apply skills, and quality of life. MATERIALS AND METHODS: 136 medical students were recruited for this non-randomized single group pre-post study, and trained using the World Health Organization (WHO) PFA guidebook. Measures include PFA knowledge, perceived ability to use PFA skills, WHO Quality of Life brief version (WHOQOL-BREF), and Helping Attitude Scale. Participants were required to fill in the questionnaire before and one month after the training. RESULTS: There were significant improvements in PFA knowledge (p<.001, Cohen’s d = 0.60), perceived ability to use PFA skills (p<.001, Cohen’s d = 0.80), psychological health (p<.001, Cohen’s d = 1.52), and quality of life (p<.001, Cohen’s d = 0.44). Brief training with various interactive teaching methods helps participants master the skills while paying attention to their emotional needs. CONCLUSION: Brief PFA training is as effective as a whole-day PFA workshop. However, regular training should be provided to increase the level of confidence of responders in dealing with crises.

Seroprevalence of Neonatal Herpes Simplex Virus Infection at A Tertiary Teaching Hospital in Malaysia

Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Neonatal herpes simplex virus (HSV) infection is generally infrequent, despite being a life-threatening illness. Knowledge of its prevalence is limited in Malaysia since most cases are asymptomatic infections and only limited routine neonatal HSV screening is conducted. This study therefore provides a comprehensive investigation of the seroprevalence of HSV-1 and HSV-2 in neonates. MATERIALS AND METHODS: Serological screening for HSV-1 IgG and HSV-2 IgG antibody tests using the Electrochemiluminescence assay was performed on serum samples of 215 neonates delivered from January until December 2022 at Hospital Universiti Sains Malaysia. RESULTS: Of the neonates, 54.4% were found to be HSV-1 positive, while 4.2% were HSV-2 positive. All the HSV-2 neonates were co-infected with HSV-1. Newborns aged 0–10 days were the most infected group by HSV-1 (92.3%) and HSV-2 (55.6%). The most reported clinical presentation was small gestational age (SGA) (60%). Microcephaly and macrocephaly were observed in one neonate each. The clinical presentations of reactive HSV-1 and HSV-2 cases revealed the presence of fever with rash in both cases. CONCLUSION: The high seroprevalence of HSV-1 is alarming. It is hoped that these data will support the advocacy of screening women for HSV before or during pregnancy as a precautionary approach to reducing the risk of vertical transmission.

Prevalence of the Unmet Needs and its Predictors among Working Mothers of Children with Epilepsy Attending Specialist Hospitals in Kelantan

Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Unmet needs arise when everyday assistance is lacking. Epilepsy's unpredictability creates significant work-family conflict for working women, potentially leading to increased unmet needs. This study aimed to determine the prevalence and the factors related with the unmet needs of working mothers with children with epilepsy (CWE) in Kelantan. MATERIALS AND METHODS: A crosssectional study using the validated Malay version of the Family Needs Survey questionnaire was conducted among 204 working mothers aged 18 to 60 of CWE attending specialist hospitals in Kelantan. Data were analysed using descriptive statistics and multiple linear regression. RESULTS: The highest unmet need was for community services (81.6%), followed by information (71.9%), social support (53.1%), financial (43.2%), explaining to others (28.9%), and family functioning (28.4%). Having follow-ups at tertiary hospitals reduced the unmet need score for information (B=-0.669, 95%CI=-1.276,0.081, p=0.021) and social support (B=-1.454, 95%CI=-2.225, -0.683, p=<0.001). Living in nuclear types of family reduced the unmet need score for community services (B=-0.669, 95%CI=-1.276,0.081, p=0.021) and information (B=-1.216, 95%CI=-1.965,-0.466, p=0.002). Working in the government sector increased the unmet need score for social support (B=0.437, 95% CI=0.062, 1.454, p=0.033). Full-time employment (B=-0.761, 95%CI=-1.244,-0.279, p=0.002) reduced the unmet need score for family functioning. Contract employment status (B=0.566, 95%CI=0.074,1.058, p=0.024) increased the unmet need score for family functioning. CONCLUSION: Mothers of CWE working in the government sector, under contract employment, and seeking follow-up care in secondary hospitals were related to higher unmet needs. The study findings may assist policymakers in introducing a child-friendly employment policy and flexible working arrangements among working parents of children with chronic illnesses such as epilepsy.

Role of Microstructural White Matter Changes of Somatosensory Cortex in Stress Among Non-Clinical Population: A Diffusion Tensor Imaging Study

Tue, 01 Oct 2024 00:00:00 +0800

Introduction: Stress is a common response to stressors or potential threats, resulting in physical, affective, and cognitive changes. Emotions are linked to interpretations of bodily alterations, with the somatosensory cortex, including the postcentral gyrus, playing a key role in emotional processing. This study aimed to investigate the relationship between stress and microstructural white matter changes in the somatosensory cortex among healthy adults, crucial for early detection and treatment of stress in non-clinical populations.

Materials and Methods: A total of 30 participants were recruited. The participants were administered the Depression, Anxiety, and Stress Scale 21 (DASS-21) questionnaire. All subjects underwent MRI brain scanning, with diffusion tensor imaging (DTI) used to assess white matter integrity. The association between stress scores in DASS-21 and DTI parameters was analyzed.

Results: A significant negative correlation between stress scores and fractional anisotropy (FA) values in the left postcentral gyrus (r = -0.393, p = 0.32) was found, indicating early impairment by stress. No significant correlation was found in the right postcentral gyrus (r = -0.300, p = 0.107).

Conclusion: Our research results demonstrated that the microstructural somatosensory cortex, especially the left postcentral gyrus, might have early changes impairment by stress using the technique of diffusion tensor imaging (DTI). Therefore, the microstructural white matter changes in the brain before suffering the disorder may be crucial and can be a novel potential biomarker for the early detection and intervention of the disease in the non-clinical population.

Effect of Tualang Honey-Mediated Silver Nanoparticles on TNF-α level, Caspase-3 Activity and Hippocampal Morphology in Kainic Acid-Induced Neurodegeneration in Male Rats

Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Despite being common disorder, the curative treatment for degenerative diseases are not yet available. Although Tualang honey (TH) has been reported to protect against neurodegeneration, but the effect of TH-mediated silver nanoparticles (THSN) on neurodegeneration is poorly understood. Thus, we conducted this study aimed to determine the effects of THSN on the levels of tumour necrosis factor alpha (TNF-α), caspase-3 activity, and hippocampal morphology in Kainic Acid (KA) induced neurodegeneration in rats. MATERIALS AND METHODS: A total of 72 Male Sprague Dawley rats were randomized into six groups which were the control, THSN 10mg, THSN 50 mg, KA only, KA+THSN 10 mg, and KA+THSN 50 mg groups. Each group was pre-treated orally with either distilled water or THSN (10 mg/kg or 50 mg/kg), according to their respective group. Following the last pre-treatment, each rat was injected with KA (15 mg/kg) or saline. After 24 h and 5 days of KA induction, all rats were sacrificed, and the hippocampus from each rat was harvested. Cresyl Violet and Fluoro Jade C staining were carried out to examine the number of viable cells and degenerating neurons. TNF-α level and caspase-3 activity in the hippocampus were measured using commercially available ELISA kits. RESULTS: Rats with KA-induced neurodegeneration demonstrated a significant increase (p<0.05) of TNF-α level and caspase-3 activity with a lower number of viable cells and increased number of degenerating neurons in the hippocampus. The pre-treatments of THSN groups improved these changes by lowering the TNF-α level and caspase-3 activity and decreasing the number of degenerating neurons. CONCLUSION: THSN could have potential neuroprotective effects in ameliorating TNF-α level, caspase-3 activity, and hippocampal damage in KA-induced male rats.

Reliability and Validity of the Sexual Intention Questionnaire for Adolescent Boys (SIQ-AB) in Malaysian Context

Nazrie Saini, Rosalia Saimon, Razitasham Safii — Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: The newly developed Sexual Intention Questionnaire for Adolescent Boys (SIQ-AB) is an adapted tool from the Youth Sexual Intention Questionnaire (YSI-Q) and Theory of Planned Behaviour (TPB), aimed to assess the influence of knowledge, permissive attitude, social norms, and self-efficacy toward the sexual intention. Thus, the aim of this study was to validate the newly developed SIQ-AB to determine Malaysian adolescent boys’ sexual intention. MATERIAL AND METHODS: The SIQ-AB validity and reliability were assessed in this study. A total sample of 252 (Exploratory Factor Analysis, n=126 and Confirmatory Factor Analysis, n=126) among adolescent boys from Serian and Kota Samarahan, Sarawak were included in this study. The exploratory factor analysis (EFA) assessed three constructs of sexual intention which include attitude, self-efficacy, and social norms with a 4-point Likert scale with a total of 19 items. The confirmatory factor analysis (CFA) assessed the TPB constructs of sexual intention, attitude, self-efficacy, and social norms with a 4-point Likert scale with a total of 19 items adopted from YSI-Q. RESULTS: The four-factor structures were supported by the EFA which had 19 items which accounted for 65.79% of the variation overall. Four items were removed due to improper positioning or low factor loading (<0.50), even though EFA supported the four-factor structure. Using Cronbach’s alpha, internal reliability varied between 0.77-0.89. Construct, convergent and composite validity of the SIQ-AB were further validated by the CFA with χ 2=199.0, df=129, p< 0.001, χ 2/df =1.54, CFI=0.98 and TLI=0.98 and RMSEA=0.06. CONCLUSIONS: The result proved that the SIQ-AB instrument is a valid and highly reliable tool to assess adolescent boys' sexual intention.

Prior Knowledge, Acceptance, Adaptation, and Challenges Following Stoma Formation among Colorectal Cancer Patients in Northern Peninsular of Malaysia: A Qualitative Study

Siti Maisarah Md Ali, Faizah Ahmad, Mohd Hadi Shafawi Mohamad Noor — Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Stoma formation affects an individual in various ways, including physical, emotional, social, and cognitive functions. Diverse studies report ways of an individual lives with new stoma formation. However, the comprehensive understanding of the entire process by the patient, which includes knowledge before the surgical procedure, as well as the subsequent acceptance, adaptation, and challenges to living with a stoma is lacking. MATERIALS AND METHODS: In-depth interview session were conducted with 12 colorectal cancer patients who have undergone surgical procedures for intestinal stoma formation. The patterns and themes within the data were identified by thematic analysis, involving data familiarisation and coding followed by themes’ generation and refinement of the themes. RESULTS: Four themes and 9 subthemes were identified, which revealed the sufficiency of stoma-related information and understanding prior to surgery as well as positive acceptance of self and family members reflected through their reactions and support. Nonetheless, the challenges were anticipated which highlights the complications of the stoma itself, obstacles surrounding social life, and financial burdens. CONCLUSION: This study provided valuable insights into the experiences of individuals living with a stoma following colorectal cancer surgery. The themes and subthemes highlight the need to address social stigma as well as financial issues to alleviate the burden of stoma-related expenses. Increasing public awareness and improving financial assistance could be a way to enhance the overall quality of life for patients living with stoma

Evaluation of Tumour-Associated Macrophages and Colony-Stimulating Factor-1 Expression in Invasive Breast Carcinoma and Their Association with Prognostic Parameters

Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Recent breast cancer research has focused on tumour microenvironment (TME). Tumour-associated macrophages (TAMs) are the key players in TME as they provide pro-tumorigenic milieu for tumour progression and metastasis. These macrophages are primarily regulated by colony-stimulating factor-1 (CSF-1) secreted by breast cancer cells. This study investigated the association of localization of TAMs infiltration within breast carcinoma and CSF-1 expression by cancer cells with the pathological prognostic parameters. MATERIALS AND METHODS: TAMs were assessed in 128 cases of invasive breast carcinoma by CD163 immunohistochemical expression. The median TAM density in both the tumour nest and tumour stroma was utilized to classify TAMs into categories of low and high infiltration. The cancer cells were immunostained with anti-CSF-1 antibody and the staining intensity was evaluated as low or high expression. RESULTS: High nest and stromal TAMs were associated with higher tumour grades (p=0.005 and p=0.0001, respectively) whereas only high stromal TAMs showed significant association with negative oestrogen and progesterone receptors status (p=0.001 and 0.001, respectively); and triple-negative subtype (p=0.002). High CSF-1 expression was significantly associated with high stromal TAMs (p=0.031). High CSF-1 expression was associated with tumour grade and positive HER2 status (p=0.008 and 0.007, respectively). CONCLUSION: TAMs in tumour nest and stroma showed varying degrees of association with the clinicopathological parameters. High CSF-1 expression was associated with unfavourable prognostic parameters. Therefore, the evaluation of TAMs and CSF-1 expressions could potentially serve as prognostic markers and cellular targets for novel treatment modality in invasive breast cancers.

Upregulation Mechanism of CCND1 in Apoptosis on MCF-7 Cell Line upon Treatment with Quranic Verses

Tue, 01 Oct 2024 00:00:00 +0800

INTRODUCTION: Ruqyah Shar'iyyah, one of the complementary and alternative medicine (CAM) has shown therapeutic benefits in breast cancer by utilizing Quranic verses in reducing symptoms and enhancing their quality of life as a result of invasive standard therapies. However, scientific evidence is required to demonstrate Ruqyah Shar'iyyah's effectiveness on gene expression and molecular pathways in carcinogenesis. Therefore, this study was conducted to evaluate the effectiveness of Ruqyah Shar’iyyah on breast cancer cell line on apoptosis and CCND1 expression in related signaling pathways. MATERIALS AND METHODS : MCF-7 cell lines were treated with direct recitation of several Quranic verses for 12 hours and 24 hours. Cell viability was observed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The expression of CCND1 was determined using RT-qPCR technique. The molecular mechanism and signalling pathways were evaluated using Reactome database for in silico analysis. RESULTS: Cell viability data showed 95.69% and 93.54% exhibiting slight reduction for 12-hour treatment in untreated and treated MCF-7, respectively. Meanwhile more reduction was observed in 24-hour treatment with 95.11% in untreated cell line as compared to 92.34% in treated cell line. The cell morphology also exhibited apoptotic activity in the treated group for both two time points. Gene expression analysis of CCNDI also demonstrated upregulation with 1.81-fold change. The data was supported by the in-silico analysis in which 25 relevant significant signalling pathways related to CCND1 highlighting the role of the gene in breast cancer development. CONCLUSION: CCND1 may have a function in signalling pathways that control the proliferation of mammary epithelial cells.

Teachers’ Knowledge, Attitude, and Practice on Schoolchildren’s Visual and Eye Health: A Scoping Review

Shazrina Ariffin, Saadah Mohamed Akhir, Sumithira Narayanasamy — Tue, 01 Oct 2024 00:00:00 +0800

Studies on knowledge, attitude, and practice (KAP) of teachers regarding schoolchildren’s visual and eye health is an important step before implementing further collaboration between education and healthcare system. The input in this field is limited as many countries are at the early stage of involving teachers in school health screening programmes. This review aims to understand the level of KAP among teachers on schoolchildren’s visual and eye health and the methodology used to conduct these studies. This scoping review was conducted based on Arksey and O’Malley’s framework for scoping studies. A systematic search using electronic databases (Scopus, Web of Science, PubMed and Ebscohost) was conducted to identify relevant articles, imported into the Rayyan web application for review management. Mendeley desktop was utilised for citation management. A total of 463 articles were identified during the selection process, and 17 articles were included in this scoping review after eligibility screening. These studies were grouped into three designs: cross-sectional, intervention, and qualitative. This scoping review revealed that the level of knowledge and practice among teachers on schoolchildren’s visual and eye health was low to moderate, while the level of attitude was good. Some misconceptions exist among teachers regarding children’s visual and eye health. Training programmes for teachers are crucial to significantly improve their KAP levels. Most of the teachers lacked the knowledge and practice concerning children’s visual and eye health. However, with a good attitude, their awareness level can be upgraded with proper training, eye screening facilities, and access to information.

Updates in Microglial Research with Respect to Brain Cancer

Hemavathy Subramaiam, Jin Hao Ma — Tue, 01 Oct 2024 00:00:00 +0800

Microglia resides in the microenvironment of the central nervous system (CNS) and is thought to play a key role in the development and progression of brain cancer. This is because it was shown that microglia comprised a large portion of the total brain tumour mass. Besides, the origin of microglia cells in brain tumours is worth understanding as it is important to distinguish the resident macrophages from the circulating macrophages when discussing the pathology of brain tumours. Activated microgliosis has been linked to increased inflammatory mediators like cytokines, growth factors, matrix metalloproteinases (MMPs) and many more, which would facilitate tumourigenesis. Brain tumour cells also proliferate under the influence of signalling pathways, such as the toll-like receptor 2 signals. Vascular endothelial growth factor (VEGF) which is an angiogenic factor aids in the growth of tumour cells. Brain cancer cells rely on suppressing the effector arm of immune system to evade attacks by downregulating major histocompatibility complexes (MHC) class II molecules and inducing the conversion of microglia to an immunosuppressive phenotype. Glioblastoma stem cells (GSCs) that give rise to brain cancers communicate with microglia cells, which determines their growth and invasion potential. Understanding the molecular interactions of brain cancer and microglia cells would help unlock novel treatments via means of immunotherapy, immunosuppressants and utilising microglia cells to deliver nanoparticle drugs to effectively target and treat brain cancer.

Barriers Towards Healthcare Access and Services among People with Disabilities: A Scoping Review of Qualitative Studies

Tue, 01 Oct 2024 00:00:00 +0800

Healthcare access and services is one of the challenges faced by people with physical disability (PWPD). PWPD also has at risk of early death and preventable chronic illness. Lack of access to healthcare services includes delay or failure to receive needed care, lack of continuity of care and financial burden will result in deterioration of health, wellbeing and functional status. The aim of this paper was to review barriers towards healthcare access and services among PWPD based on the existing qualitative studies. We conducted a scoping review of relevant qualitative articles from PubMed, Scopus and ProQuest. The article search was based on the available keyword in the title with the publication restricted within 10 years (between 2012 to 2021). The search strategy was conducted using MeSH terms of ‘barriers, healthcare access, healthcare services and physical disability’. In this review, people with different kinds of physical disabilities were included. There were 2004 articles obtained from the initial search. 27 articles met the inclusion criteria for the final review. In each study, PWPD noted various barriers to access healthcare services. Findings from this review revealed five themes: personal; financial; attitudinal and communication; health system; structural and physical barriers. The findings showed that PWPD faces various barriers when accessing healthcare services. Addressing these barriers could help create a healthcare system that is inclusive and accessible for all.