Sarawak Biodiversity Centre

BackgroundLung cancer is the most frequently diagnosed cancer globally. In Malaysia, it ranks as the second most common cancer among men and third among women. Presently, no local clinical practice guidelines exist for lung cancer care in Malaysia. Given the lack of consensus regarding the perioperative management of early-stage non-small cell lung cancer (NSCLC), this article seeks to harmonise surgical practices among thoracic physicians and surgeons in Malaysia by recommending best practices for screening, diagnosis and staging, as well as multimodal management and surveillance in early-stage disease (stages I to IIIB-N2).MethodsA local expert committee comprising nine high-volume actively practicing cardiothoracic or general thoracic surgeons gathered between February to July 2024 to deliberate existing evidence and formulate recommendations. A modified Delphi method comprising systematic review of published evidence and expert opinion based on local experience was utilised. The document was subsequently independently reviewed by two senior oncologists and two senior respiratory physicians, before incorporating their feedback into the final version.ResultsThis document comprises a surgical consensus of evidence-based guidelines to provide local recommendations on contemporary real-world best practices. The consensus statements were grouped into five domains of early-stage resectable NSCLC: (I) screening (3 statements); (II) diagnosis and staging (6 statements); (III) neoadjuvant/perioperative immunotherapy (3 statements); (IV) adjuvant therapy with tyrosine kinase inhibitors (TKIs) or immunotherapy (4 statements); and (V) operative metrics and post-operative surveillance (5 statements).ConclusionsThese consensus statement guidelines will elevate and standardise the perioperative management of early-stage NSCLC in Malaysia, serve as a valuable educational and training tool for relevant medical professionals, and promote an inclusive, comprehensive multidisciplinary approach to integrated holistic patient care, aimed at improving both clinical outcomes and patients’ quality of life with the best available evidence.

ObjectivesThis study quantified the health and economic benefits of improving low-density lipoprotein cholesterol (LDL-C) control in Malaysian patients with established atherosclerotic cardiovascular disease (ASCVD). It aimed to inform policy discussions and healthcare planning for effective ASCVD management. MethodsA deterministic, prevalence-based model was used to project the annual health burden and direct medical costs associated with recurrent ASCVD events over a 10-year horizon. The target population included adults (≥30 years) with established ASCVD and uncontrolled LDL-C levels (>1.8 mmol/L). The model comprised 3 modules: population size projection, recurrent ASCVD risk calculation (by means of the Secondary Manifestations of ARTerial disease [SMART] risk model), and direct medical and productivity cost estimation. The current status quo and a scenario with a 50% improvement in mean LDL-C were compared. ResultsWe projected over 800 000 adults with established ASCVD in 2023, increasing to approximately 1.4 million by 2032. Under the status quo, about 55 000 recurrent ASCVD events were expected within 10 years, with significant direct medical costs and productivity losses. Improved LDL-C control could potentially reduce recurrent events by 7000 cases (13% reduction), prevent 2100 premature deaths, and save approximately 32 400 years of life. Economically, this could lead to a reduction of approximately 72 million MYR in direct medical costs and a gain of approximately 132.4 million MYR in productivity over a decade. ConclusionsOptimizing LDL-C control in high-risk patients with ASCVD presents a critical opportunity to reduce health and economic burdens in Malaysia.

Introduction: The integration of laser technology in urologic interventions, especially ureteral lithotripsy, has greatly advanced the field, with laser lithotripsy becoming the preferred method for treating ureteric stones via ureteroscopy. Recent advancements focus on enhancing power settings and reducing operating times, introducing high-power laser equipment capable of frequencies up to 120 Hz. However, concerns arise regarding thermal injuries to adjacent tissues due to increased energy delivery, potentially causing ureteric strictures. Objective: To explore temperature dynamics during ureteroscopic laser lithotripsy, considering factors like laser power settings and ureteroscope size, to optimize outcomes and mitigate risks for patients. Methods: A simulated in vitro model for ureteroscopic laser lithotripsy was designed with a holmium laser. Measurements of the temperature were recorded using a thermocouple placed at the laser tip at different sizes of ureteroscope (URS 6.0 Fr and URS 7.0 Fr), holmium laser (272 µm and 365 µm), various power settings (5 to 25 Hz; 0.2 to 3.0 J) and activation durations (3 to 30 s). Analysis of the variables associated with temperature change was performed. Results: All of the variables showed rising temperature trends as the laser activation time was prolonged, while ureteroscope size had no significant impact. Smaller laser fibers exhibited lower overall temperature profiles, around 34–35 °C. Notably, power settings significantly influenced temperature, with a substantial rise at 20 W (42.62 °C) and 30 W (40.02 °C). There was a significant rise in temperature as power (J × Hz) increased, where frequency carries a higher effect than energy at the same power setting. Conclusions: The recommendation includes exercising caution with higher power levels, shorter activation times, and preferably using small-caliber laser fibers to maintain lower temperatures.

With more than 100 rubber-degrading strains being reported, only 9 Lcp proteins isolated from Nocardia, Gordonia, Streptomyces, Rhodococcus, Actinoplanes, and Solimonas have been purified and biochemically characterized. A new strain, Dactylosporangium sp. AC04546 (strain JCM34239), isolated from soil samples collected in Sarawak Forest, was able to grow and utilize natural or synthetic rubber as the sole carbon source. Complete genome of Strain AC04546 was obtained from the hybrid assembly of PacBio Sequel II and Illumina MiSeq. Strain AC04546 has a large circular genome of 13.08 Mb with a G+C content of 72.1%. The genome contains 11,865 protein-coding sequences with 3 latex clearing protein (lcp) genes located on its chromosome. The genetic organization of the lcp gene cluster is similar to two other reported rubber-degrading strains-Actinoplanes sp. OR16 and Streptomyces sp. CFMR 7. All 3 Lcp from strain AC04546 were expressed in Escherichia coli and exhibited degrading activity against natural rubber. The distinctiveness of strain AC04546, along with other characterized rubber-degrading strains, is reported here.

Tremendous CO2 emissions from various industries cause environmental complications such as ocean acidification and global warming. The cement industry contributes to 2.53 billion tCO2/yr emissions globally. In an effort to remedy this problem, this research aims to implement the accelerated weathering of limestone (AWL) process to capture CO2 from cement industry emissions. The AWL absorption process utilizes a counter-current flow with a limestone-packed-bed column height of 0.876 m, a diameter of 0.102 m, and a working limestone packing volume of 0.0056 m3. A correlation study was conducted to study the effect of the liquid-to-gas (L/G) ratio on effluent alkalinity and CO2 capture efficiency. It was found that when the L/G ratio decreases (1 to 0.003), a significant increase in the alkalinity (0.62 to 2.43 mM) and pH (6.34 to 7.32) of the calcium bicarbonate (Ca(HCO3)2) effluent was observed. This was due to the longer retention time under a lower L/G ratio operation. On the flip side, the CO2 capture efficiency (70.82 to 16.98 %) of the AWL system responded negatively to the decrease in the L/G ratio. During a low L/G ratio configuration, the rate at which the system reaches equilibrium is more rapid. Results from the correlation study were used to determine the optimum operating condition simulated via the Design of Expert (DoE) software. Two optimized conditions to obtain maximum alkalinity and maximum CO2 capture efficiency were identified and validated experimentally. The highest possible alkalinity and CO2 capture efficiency obtainable were 2.43 mM and 73.51 %, respectively. Overall, this research serves as a preliminary study for the potential future commercialization of the AWL process.

Inhibition of eukaryotic initiation factor 4A has been proposed as a strategy to fight pathogens. Rocaglates exhibit the highest specificities among eIF4A inhibitors, but their anti-pathogenic potential has not been comprehensively assessed across eukaryotes. In silico analysis of the substitution patterns of six eIF4A1 aa residues critical to rocaglate binding, uncovered 35 variants. Molecular docking of eIF4A:RNA:rocaglate complexes, and in vitro thermal shift assays with select recombinantly expressed eIF4A variants, revealed that sensitivity correlated with low inferred binding energies and high melting temperature shifts. In vitro testing with silvestrol validated predicted resistance in Caenorhabditiselegans and Leishmaniaamazonensis and predicted sensitivity in Aedes sp., Schistosomamansoni, Trypanosomabrucei, Plasmodiumfalciparum, and Toxoplasmagondii. Our analysis further revealed the possibility of targeting important insect, plant, animal, and human pathogens with rocaglates. Finally, our findings might help design novel synthetic rocaglate derivatives or alternative eIF4A inhibitors to fight pathogens.

Palliative care in Sarawak is mainly provided by health care professionals with limited formal training in palliative care. Therefore, in 2020, collaborative work between Sarawak General Hospital, University Malaysia Sarawak, and ASCO began. This study reports on the outcome of this collaboration. The collaboration was initiated with the first ASCO Palliative Care e-course, Train the Trainer program, International Development and Education Award-Palliative Care and translation of ASCO Palliative Care Interdisciplinary Curriculum resources. This collaboration has resulted in the change of practice of palliative care among the oncology team of Sarawak General Hospital. It encourages more timely palliative care referrals to ensure that patients with complex physical, psychosocial, and spiritual needs have the necessary input and support from the palliative care team throughout the course of patients' illnesses.