Review Deciphering the Anticancer Efficacy of Resveratrol and their Associated Mechanisms in Human Carcinoma.

The scientific world has recently shown wider attention to elucidating the anticancerous potential of numerous plant-based bioactive compounds. Many research studies have suggested that consuming foods high in polyphenols, which are present in large amounts in grains, legumes, vegetables, and fruits, may delay the onset of various illnesses, including cancer. Normal cells with genetic abnormalities begin the meticulously organized path leading to cancer, which causes the cells to constantly multiply, colonize, and metastasize to other organs like the liver, lungs, colon, and brain. Resveratrol is a naturally occurring stilbene and non-flavonoid polyphenol, a phytoestrogen with antioxidant, anti-inflammatory, cardioprotective, and anticancer properties. Resveratrol makes cancer cells more susceptible to common chemotherapeutic treatments by reversing multidrug resistance in cancer cells. This is especially true when combined with clinically used medications. Several new resveratrol analogs with enhanced anticancer effectiveness, absorption, and pharmacokinetic profile have been discovered. The present emphasis of this review is the modulation of intracellular molecular targets by resveratrol in vivo and in vitro in various malignancies. This review would help future researchers develop a potent lead candidate for efficiently managing human cancers.

A study on managing plastic waste to tackle the worldwide plastic contamination and environmental remediation.

Over the past 50 years, the emergence of plastic waste as one of the most urgent environmental problems in the world has given rise to several proposals to address the rising levels of contaminants associated with plastic debris. Worldwide plastic production has increased significantly over the last 70 years, reaching a record high of 359 million tonnes in 2020. China is currently the world's largest plastic producer, with a share of 17.5%. Of the total marine waste, microplastics account for 75%, while land-based pollution accounts for responsible for 80-90%, and ocean-based pollution 10-20% only in overall pollution problems. Even at small dosages (10 µg/mL), microplastics have been found to cause toxic effects on human and animal health. This review examines the sources of microplastic contamination, the prevalent reaches of microplastics, their impacts, and the remediation methods for microplastic contamination. This review explains the relationship between the community composition and the presence of microplastic particulate matter in aquatic ecosystems. The interaction between microplastics and emerging pollutants, including heavy metals, has been linked to enhanced toxicity. The review article provided a comprehensive overview of microplastic, including its fate, environmental toxicity, and possible remediation strategies. The results of our study are of great value as they illustrate a current perspective and provide an in-depth analysis of the current status of microplastics in development, their test requirements, and remediation technologies suitable for various environments.

Spatial Distribution and Long-Term Persistence of Wolbachia-Infected Aedes aegypti in the Mentari Court, Malaysia.

Dengue is endemic in Malaysia, and vector control strategies are vital to reduce dengue transmission. The Wolbachia strain wAlbB carried by both sexes of Ae. aegypti was released in Mentari Court, a high-rise residential site, in October 2017 and stopped after 20 weeks. Wolbachia frequencies are still being monitored at multiple traps across this site, providing an opportunity to examine the spatiotemporal distribution of Wolbachia and mosquito density with respect to year, residential block, and floor, using spatial interpolation in ArcGIS, GLMs, and contingency analyses. In just 12 weeks, Wolbachia-infected mosquitoes were established right across the Mentari Court site with an overall infection frequency of >90%. To date, the Wolbachia frequency of Ae. aegypti has remained high in all areas across the site despite releases finishing four years ago. Nevertheless, the Wolbachia invaded more rapidly in some residential blocks than others, and also showed a relatively higher frequency on the eighth floor. The Ae. aegypti index tended to differ somewhat between residential blocks, whilst the Ae. albopictus index was relatively higher at the top and bottom floors of buildings. In Mentari Court, only a short release period was required to infiltrate Wolbachia completely and stably into the natural population. The results inform future releases in comparable sites in a dengue control programme.

Engineering Approaches for Breast Cancer Diagnosis: A Review.

Breast cancer is a leading cause of mortality among women. The patient's survival rate is uncertain due to the limitations in the accuracy of diagnosis and effective monitoring during cancer treatment. The key to efficaciously controlling cancer on a larger scale is effective diagnosis at an early stage of cancer by distinguishing the vital signatures of the diseased from the normal breast tissue. The breast tissue is a heterogeneous turbid media that exhibits multifaceted bulk tissue properties. Various sensing modalities can yield distinct tissue behavior for cancer and adjacent normal tissues, serving as a basis for cancer diagnosis. A novel multimodal diagnostic tool that can concurrently assess the optical, electrical, and mechanical bulk tissue properties can substantially augment the clinical findings such as histopathology, potentially aiding the clinician to establish an accurate and rapid diagnosis of cancer. This review aims to discuss the clinical and engineering aspects along with the unmet challenges of these physical sensing modalities, primarily in the field of optical, electrical, and mechanical. The challenges of combining two or more of these sensing modalities that can significantly enhance the effectiveness of the clinical diagnostic tools are further investigated.

Toward the development of a polarimetric tool to diagnose the fibrotic human ventricular myocardium.

SIGNIFICANCE: Optical polarimetry is an emerging modality that effectively quantifies the bulk optical properties that correlate with the anisotropic structural properties of cardiac tissues. We demonstrate the application of a polarimetric tool for characterizing healthy and fibrotic human myocardial tissues efficiently with a high degree of accuracy. AIM: The study was aimed to characterize the myocardial tissues from the left ventricle and right ventricle of N = 7 control and N = 10 diseased subjects. The diseased subjects were composed of two groups: N = 7 with rheumatic heart disease (RHD) and N = 3 with myxomatous valve (MV) disease. APPROACH: A portable, affordable, and accurate linear polarization-based diagnostic tool is developed to measure the degree of linear polarization (DOLP) of the myocardial tissues while working at a wavelength of 850 nm. RESULTS: The sensitivity, specificity, and accuracy of the polarimetric tool in distinguishing the control group from the RHD group were found to be 73.33%, 76.92%, and 75%, respectively, and from the MV group were 91.6%, 62.5%, and 80%, respectively, which demonstrates the efficacy of the polarimetric tool to distinguish the healthy myocardial tissues from diseased tissues. CONCLUSIONS: We have successfully developed a polarimetric tool that can aid cardiologists in characterizing the myocardial tissues in conjunction with endomyocardial biopsy. This work should be followed up with experiments on a large cohort of control and diseased subjects. We intend to create and develop a probe to quantify the DOLP of in vivo heart tissue during surgery.

Implant positioning in total hip arthroplasty: influence of horizontal and vertical offset on functionality of prosthetic hip joint.

PURPOSE: To analyze the effect of implant position measured in terms of offset on patient reported outcomes (PRO) following hip arthroplasty (THA). METHODS: A total of 243 patients of the total hip replacement who had a one year follow-up were included in the study. Standard both hips radiograph was used to asses post-surgery implant position in terms of horizontal offset and vertical offset, and correlated with functional outcome which was evaluated as change in PRO. i.e., Harris hip score (HHS) post-op. With center of hip rotation as reference, horizontal offset was calculated as sum of distance, of centre, from proximal femoral shaft axis and a vertical line through ipsilateral teardrop, and vertical offset as limb length discrepancy. Post-op patients were classified into three groups depending on the measurement of horizontal offset of the operated hip. The patients having operated hip horizontal offset within 5 mm of the normal hip were grouped as restored offset (RO); those having shorter or higher offset by more than 5 mm compared to normal hip were labeled as decreased (DO) or increased offset (IO) group respectively. The groups were further subdivided into suboptimal and optimal function groups based on HHS, and among these groups, limb length discrepancy was evaluated. RESULTS: Post follow-up mean HHS (78.23 ± 9.96) improved significantly in all three groups (p < 0.0001). The difference in post-operative HHS among DO, RO, and IO groups was significant, with their averages being 72.5 ± 4.7, 82.1 ± 6.5, and 75.2 ± 4.8 respectively (p = .01). Limb length discrepancy was significantly more common in patients with suboptimal functional scores in all three groups. CONCLUSION: This study concluded that both horizontal offset and vertical offset should be reconstructed in patients operated with unilateral THR due to hip pathology, since both factor demonstrated a comparable additive effect on clinical outcome.

Toward the development of portable light emitting diode-based polarization spectroscopy tools for breast cancer diagnosis.

A robust, affordable and portable light emitting diode-based diagnostic tools (POLS-NIRDx) using a polarization-sensitive (linear as well as circular polarization) technique were designed and developed to quantify the degree of linear polarization (DOLP), degree of circular polarization (DOCP). The study was performed on malignant (invasive ductal carcinoma) and adjacent normal ex-vivo biopsy tissues excised from N = 10 patients at the operating wavelengths of 850 and 940 nm. The average DOLP and DOCP values were lower for malignant than adjacent normal while operating at 850 and 940 nm. The highest accuracy was observed for DOLP (100%) and DOCP (80%) while operating at 850 nm, which reduced (80% for DOLP and 65% for DOCP) at 940 nm. This pilot study can be utilized as a differentiating factor to delineate malignant tissues from adjacent normal tissues.

Anticancer Potential of Naringenin, Biosynthesis, Molecular Target, and Structural Perspectives.

Numerous novel medicinal agents isolated from plant sources were used as indigenous remedies for the management and treatment of various types of cancer diseases. Naringenin is a naturally occurring flavanone glycoside, and aglycone (genin) moiety of naringin, predominantly found in citrus and grapefruits, has emerged as a potential therapeutic agent for the management of a variety of diseases. A number of scientific papers have been published on naringenin describing its detailed studies and its therapeutic application in different diseases. The current study highlights a comprehensive study on naringenin concerning its biosynthesis, molecular targets/pathways involved in carcinogenesis, mechanism of actions (MOAs), and structure-activity relationships (SARs), and patents granted have been highlighted. Naringenin and its derivatives have great anti-cancer activity due to their inhibitory potential against diverse targets, namely ABCG2/P-gp/BCRP, 5a-reductase, 17- bhydroxysteroid dehydrogenase, aromatase, proteasome, HDAC/Situin-1, VEGF, VEGFR-2 kinase, MMP-2/9, JAK/STAT signaling pathways, CDC25B, tubulin, topoisomerase-II, cathepsin-K, Wnt, NF-kB, B-Raf and mTOR, etc. With the in-depth knowledge of molecular targets, structural intuition, and SARs, the current study may be beneficial to design more potent, safe, effective, and economic anti-cancer naringenin. This has been concluded that naringenin is a promising natural product for the management and therapy of cancer. Further evolution for pharmacological importance, clinical research, and trials are required to manifest its therapeutic action on metabolic syndrome in the human community.

Influenza in Malaysian adult patients hospitalized with community-acquired pneumonia, acute exacerbation of chronic obstructive pulmonary disease or asthma: a multicenter, active surveillance study.

BACKGROUND: Available data on influenza burden across Southeast Asia are largely limited to pediatric populations, with inconsistent findings. METHODS: We conducted a multicenter, hospital-based active surveillance study of adults in Malaysia with community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute exacerbation of asthma (AEBA), who had influenza-like illness ≤10 days before hospitalization. We estimated the rate of laboratory-confirmed influenza and associated complications over 13 months (July 2018-August 2019) and described the distribution of causative influenza strains. We evaluated predictors of laboratory-confirmed influenza and severe clinical outcomes using multivariate analysis. RESULTS: Of 1106 included patients, 114 (10.3%) were influenza-positive; most were influenza A (85.1%), with A/H1N1pdm09 being the predominant circulating strain during the study following a shift from A/H3N2 from January-February 2019 onwards. In multivariate analyses, an absence of comorbidities (none versus any comorbidity [OR (95%CI), 0.565 (0.329-0.970)], p = 0.038) and of dyspnea (0.544 (0.341-0.868)], p = 0.011) were associated with increased risk of influenza positivity. Overall, 184/1106 (16.6%) patients were admitted to intensive care or high-dependency units (ICU/HDU) (13.2% were influenza positive) and 26/1106 (2.4%) died (2.6% were influenza positive). Males were more likely to have a severe outcome (ICU/HDU admission or death). CONCLUSIONS: Influenza was a significant contributor to hospitalizations associated with CAP, AECOPD and AEBA. However, it was not associated with ICU/HDU admission in this population. Study registration, NMRR ID: NMRR-17-889-35,174.

Asymptomatic Lymphocytic Interstitial Pneumonia with Extensive HRCT Changes Preceding Sjogren's Syndrome.

Lymphocytic interstitial pneumonia (LIP) is a rare condition, commonly associated with Sjogren's syndrome (SS). We report a 53-year-old woman with an incidental finding of an abnormal chest radiograph. LIP was diagnosed based on high-resolution computed tomography and lung biopsy, but treatment was not initiated. Six years later, she developed cough and dyspnoea, associated with dry eyes, dry mouth, and arthralgia. While being investigated for the respiratory symptoms, she developed cutaneous vasculitis and was treated with 1 mg/kg prednisolone, which resulted in the improvement of her respiratory symptoms. Physical examination revealed fine bibasal crepitations, active vasculitic skin lesions, and a positive Schirmer's test. Investigations revealed a restrictive pattern in the pulmonary function test, stable LIP pattern in HRCT, and positive anti-Ro antibodies. She was treated with prednisolone and azathioprine for 18 months, and within this time, she was hospitalised for flare of LIP, as well as respiratory tract infection on three occasions. During the third flare, when she also developed cutaneous vasculitis, she agreed for prednisolone but refused other second-line agents. To date, she remained well with the maintenance of prednisolone 2.5 mg monotherapy for more than one year. The lessons from this case are (i) patients with LIP can be asymptomatic, (ii) LIP can precede symptoms of SS, and (iii) treatment decision for asymptomatic patients with abnormal imaging or patients with mild severity should be weighed between the risk of immunosuppression and risk of active disease.

Elucidation of S-Allylcysteine Role in Inducing Apoptosis by Inhibiting PD-L1 Expression in Human Lung Cancer Cells.

AIM: The aim of this study is to explore the therapeutic potential of S-allylcysteine (SAC) organosulphur compound as a potent immune checkpoint inhibitor PD-L1. BACKGROUND: Natural compounds have been showing tremendous anticancerous potential via suppressing the expression of genes involved in the development and progression of several carcinomas. This has further motivated us to explore the therapeutic potential of organosulphur compounds as potent immune checkpoint inhibitors. OBJECTIVE: Our study was designed to elucidate the potential of S-allylcysteine (SAC) as significant PD-L1 (immune checkpoint) inhibitor in human lung cancer A549 cancer cell line by using both the in vitro and in silico approaches. METHODS: Anticancerous effect of the SAC on lung cancer cells was determined by using the MTT cell viability. Apoptotic induction was confirmed by Hoechst staining, percent caspase-3 activity as well as gene expression analysis by real time PCR. Reactive Oxygen Species (ROS) was estimated by DCFDA method. Additionally, ligand-target protein interaction was analysed by molecular docking. RESULT: Cell growth and proliferation was significantly reduced in SAC treated A549 cells in a concentration and time.dependent manner. The effect of SAC on apoptotic induction was analyzed by enhanced nuclear condensation, increased percent caspase-3 activity as well as modulation of apoptotic genes. Furthermore, SAC treatment also resulted in reduced expression of PD-L1 and HIF-1α. Additionally, in silico analysis also supported the in vitro findings by showing efficient docking with PD-L1 immune checkpoint target. CONCLUSION: Therefore, our results clearly suggested that SAC could serve as a novel chemotherapeutic candidate for the treatment of lung cancer by inhibiting immune checkpoint target PD-L1 in human lung cancer cells. Additionally, our study also explained a novel molecular mechanism of its antitumor activity.

Influence of Beginning Time of Casting for Clubfoot Treatment by Ponseti Method in Different Age Group Infants: A Retrospective Study.

BACKGROUND: The clubfoot is one of the commonly found congenital deformities in newborn. The Ponseti method is the most effective nonoperative clubfoot management method. It is based on understanding of pathoanatomy of clubfoot. For classifying severity of clubfoot, Pirani score is used. The number of cast required for clubfoot correction is dependent on its initial Pirani score. This study aimed on how the number of cast for correction of clubfoot deformity depends on starting time of casting and pretreatment Pirani score. MATERIALS AND METHODS: This study comprises of 200 patients with 297 affected foot nonoperatively managed with Ponseti technique of casting. We measured initial and final Pirani scores of patients with different age groups. RESULTS: We found that initial severity was less in 0-1 month age group children but mean casting number was more while initial severity was more in 1-2 month age group, the mean number of casting was less. Tenotomy requirement was also less in 1-2 month age group. CONCLUSION: We concluded that casting according to the Ponseti method should be started in 1-2 months age group which shows better results than the other age groups in clubfoot.

An elusive endosymbiont: Does Wolbachia occur naturally in Aedes aegypti?

Wolbachia are maternally inherited endosymbiotic bacteria found within many insect species. Aedes mosquitoes experimentally infected with Wolbachia are being released into the field for Aedes-borne disease control. These Wolbachia infections induce cytoplasmic incompatibility which is used to suppress populations through incompatible matings or replace populations through the reproductive advantage provided by this mechanism. However, the presence of naturally occurring Wolbachia in target populations could interfere with both population replacement and suppression programs depending on the compatibility patterns between strains. Aedes aegypti were thought to not harbor Wolbachia naturally but several recent studies have detected Wolbachia in natural populations of this mosquito. We therefore review the evidence for natural Wolbachia infections in A. aegypti to date and discuss limitations of these studies. We draw on research from other mosquito species to outline the potential implications of natural Wolbachia infections in A. aegypti for disease control. To validate previous reports, we obtained a laboratory population of A. aegypti from New Mexico, USA, that harbors a natural Wolbachia infection, and we conducted field surveys in Kuala Lumpur, Malaysia, where a natural Wolbachia infection has also been reported. However, we were unable to detect Wolbachia in both the laboratory and field populations. Because the presence of naturally occurring Wolbachia in A. aegypti could have profound implications for Wolbachia-based disease control programs, it is important to continue to accurately assess the Wolbachia status of target Aedes populations.

Guggulipid: A Promising Multi-Purpose Herbal Medicinal Agent.

Herbal medicines therapy is appreciated by many research works because herbal drugs have relatively high therapeutic window, lower side effects and more cost effective. Guggulipid is an ethyl acetate extract of resin known as guggul from the tree Commiphora wightii / mukul (Arn.) Bhandari. Chemical analysis revealed that the compounds responsible for the major activities of gum guggul are the isomers E- and Z-guggulsterone. Guggul has been used for thousands of years in the treatment of arthritis, inflammation, obesity, cardiac protection, anti-ulcer, anti-epileptic and disorders of lipid metabolism. This review is an assortment of available information reported on its chemical, pharmacological and toxicological properties in various research studies. The available therapeutic properties of guggulipid make it suitable natural product for the treatment of various disorders like inflammation, pain, wounds, liver disorder and Acne etc. Graphical Abstract Graphical Abstract.

Personalised management of Chronic Obstructive Pulmonary Disease (COPD): Malaysian consensus algorithm for appropriate use of inhaled corticosteroid (ICS) in COPD patients

@#Background: Regarding the long-term safety issues with the use of inhaled corticosteroids (ICS) and the clinical predominance of dual bronchodilators in enhancing treatment outcomes in chronic obstructive pulmonary disease (COPD), ICS is no longer a “preferred therapy” according to the Global Initiative for Chronic Obstructive Lung Disease except on top of a dual bronchodilator. This has necessitated a change in the current therapy for many COPD patients. Objective: To determine a standardised algorithm to reassess and personalise the treatment COPD patients based on the available evidence. Methods: A consensus statement was agreed upon by a panel of pulmonologists in from 11 institutes in Malaysia whose members formed this consensus group. Results: According to the consensus, which was unanimously adopted, all COPD patients who are currently receiving an ICS-based treatment should be reassessed based on the presence of co-existence of asthma or high eosinophil counts and frequency of moderate or severe exacerbations in the previous 12 months. When that the patients meet any of the aforementioned criteria, then the patient can continue taking ICS-based therapy. However, if the patients do not meet the criteria, then the treatment of patients need to be personalised based on whether the patient is currently receiving long-acting beta-agonists (LABA)/ICS or triple therapy. Conclusion: A flowchart of the consensus providing a guidance to Malaysian clinicians was elucidated based on evidences and international guidelines that identifies the right patients who should receive inhaled corticosteroids and enable to switch non ICS based therapies in patients less likely to benefit from such treatments.

Establishment of Wolbachia Strain wAlbB in Malaysian Populations of Aedes aegypti for Dengue Control.

Dengue has enormous health impacts globally. A novel approach to decrease dengue incidence involves the introduction of Wolbachia endosymbionts that block dengue virus transmission into populations of the primary vector mosquito, Aedes aegypti. The wMel Wolbachia strain has previously been trialed in open releases of Ae. aegypti; however, the wAlbB strain has been shown to maintain higher density than wMel at high larval rearing temperatures. Releases of Ae. aegypti mosquitoes carrying wAlbB were carried out in 6 diverse sites in greater Kuala Lumpur, Malaysia, with high endemic dengue transmission. The strain was successfully established and maintained at very high population frequency at some sites or persisted with additional releases following fluctuations at other sites. Based on passive case monitoring, reduced human dengue incidence was observed in the release sites when compared to control sites. The wAlbB strain of Wolbachia provides a promising option as a tool for dengue control, particularly in very hot climates.

Solution-Processable Vertical Organic Light-Emitting Transistors (VOLETs) with Directly Deposited Silver Nanowires Intermediate Source Electrode.

A simple spin-coating process for fabricating vertical organic light-emitting transistors (VOLETs) is realized by utilizing silver nanowire (AgNW) as a source electrode. The optical, electrical and morphological properties of the AgNW formation was initially optimized, prior VOFET fabrication. A high molecular weight of poly[2-methoxy-5-(2-ethylhexyloxy)-1,4-phenylenevinylene] MEH-PPV was used as an organic semiconductor layer in the VOFET in forming a multilayer structure by solution process. It was found that current density and luminance intensity of the VOLET can be modulated by a small magnitude of gate voltage. The modulation process was induced by changing an injection barrier via gate voltage bias. A space-charge-limited current (SCLC) approach in determining transistor mobility has been introduced. This preliminary and fundamental work is beneficial towards all-solution processing display devices.

Assessment of Self-Stigma, Self-Esteem, and Asthma Control: A Preliminary Cross-Sectional Study Among Adult Asthmatic Patients in Selangor, Malaysia.

Purpose: The elusive goal of asthma management guidelines is to achieve and maintain good asthma control in asthmatic patients. Against a background of long-term respiratory limitations when living with asthma, stigma and low self-esteem have also been identified as the social phenomenon among adult asthmatics. This study aimed to assess the levels of self-stigma, self-esteem, and asthma control, and to investigate the impact of self-stigma and self-esteem as psychosocial factors on asthma control in Malaysian adults living with asthma. Materials and Methods: In this multicenter cross-sectional study, post-ethics approval and patients' consents, 152 stable asthmatic patients (aged > 18 years old; nil cognitive disability; not diagnosed with other respiratory diseases) were recruited from four respiratory clinics in Selangor, Malaysia. The patients' socio-demographic, medical, and psychosocial (self-stigma and self-esteem) data were recorded in a pre-validated, self-designed questionnaire. All data were analyzed descriptively and inferentially (independent t-test/one-way ANOVA, and multiple linear regression) using the Statistical Package for Social Sciences (SPSS®). Results: The enrolled patients showed moderate levels of self-stigma (62.12 ± 6.44) and self-esteem (29.31 ± 3.29), and not well-controlled asthma (17.58 ± 3.99). The number of patients' visits to emergency rooms because of asthma [CI (-1.199, 0.317), p < 0.001] was the significant predictor to asthma control among all selected study variables from socio-demographic and medical data. Moreover, from psychosocial factors both self-stigma [CI (-0.367, 0.190), p < 0.001], and self-esteem [CI (-0.007, 0.033), p = 0.041] found to be the significant predictors of asthma control. Conclusion: The preliminary evidences presented in this study found that frequent emergency room visits, high self-stigma and low self-esteem in asthma patients becomes more apparent with poor asthma control. Educational interventions to reduce patients' self-stigma and improve self-esteem are needed to achieve optimal control of asthma.

Adaptation and Validation of the Malay Version of the Osteoarthritis Knee and Hip Quality of Life Questionnaire among Knee Osteoarthritis Patients.

OBJECTIVE: To adapt and validate the Malay version of Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire. DESIGN: The OAKHQOL was adapted into Malay version using forward-backward translation methodology. It was then validated in a cross-sectional study of 191 patients with knee osteoarthritis (OA). Patients completed the OAKHQOL and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Confirmatory analysis, reliability analysis, and Pearson correlation test were performed. RESULTS: The new five-factor model of 28 items demonstrated an acceptable level of goodness of fit (comparative fit index = 0.915, Tucker-Lewis index = 0.905, incremental fit index = 0.916, chi-squared/degree of freedom = 1.953, and root mean square error of approximation = 0.071), signifying a fit model. The Cronbach's alpha value and the composite reliability of each construct ranged from 0.865 to 0.933 and 0.819 to 0.921, respectively. The Pearson correlation coefficient between the OAKHQOL and the WOMAC showed adequate criterion validity. Known groups validity showed statistical difference in body mass index in physical activity, mental health, and pain construct. The pain domain was statistically different between the age groups. CONCLUSION: The Malay version OAKHQOL questionnaire is a valid and reliable instrument to assess health-related quality of life in knee OA patients.

Management of asthma in adults in primary care

@#Asthma is a chronic inflammatory disease of the airway which is often misdiagnosed and undertreated. Early diagnosis and vigilant asthma control are crucial to preventing permanent airway damage, improving quality of life and reducing healthcare burdens. The key approaches to asthma management should include patient empowerment through health education and selfmanagement and, an effective patient-healthcare provider partnership.