RMU Update: How Malaysia fared in World CUCMS Re:Search Bulletin University Rankings April 2017 Volume 6 Hot topic: Therapeutic overclaims of supplements CUCMS Expert: Prof Dr Rosnah Ismail Free Copy Editor’s Titbits Table of Content The start of 2017 has been colourful. The Ministry of Higher Education has shared with the Research Management Unit the Editor’s Titbits 2 performance of Malaysian Universities in the World ranking and From the horse’s mouth: 3 also some key information pertaining to the trends and issues in How Malaysia fared in World University Rankings government grant applications. It is hoped that this information Hot Topic: 8 could be used by our researchers to strategize the bidding of Weight loss herbal supplements: Boon or Bane? grants and avoid the common pitfalls mentioned in the report. More Hot Topic: 10 about this is shown in the RMU Update: From the Horse’s Mouth. Skin whitening products is not so fair and lovely after all Hot Topic: 12 Nevertheless, our researchers have been very active and several Over Claim of Health Supplement Products in Malaysia of our academicians’ work is showcased in Crème de la crème in Hot Topic: 14 the form of extended abstracts and also posters. The various Evidence-Based Medicine faculties of CUCMS have also shared their research updates and it 1-Minute-Lesson: 14 is exciting to see such dedication and that our research is thriving! Journal Citation Ranking and Quartile Scores (Q1-Q4) Research Poster 15 The Hot Topic selected for this issue is Therapeutic Over claim. The Editorial Members have come together to get the input from all From Nothing to Something CUCMS Greenhouse 16 faculties in order to give a well-rounded discussion of the topic. CUCMS Expert: Prof Dr Rosnah Ismail 18 Any suggestions for a suitable focus for our bulletin are welcome Research Poster 20 and can be forwarded to the Editorial Members. Employee of the Quarter 21 CGSRC has started the year with many events and particularly CUCMS Annual Dinner 22 one stood out: the CGSRC Roadshow. One of the main focuses of the event was to brief all CUCMS academicians regarding the Research Poster 24 Malaysian Research Instrument (MyRA). MyRA is the benchmark Centre for Languages and General Studies (CLGS) 25 used by Malaysian universities in order to evaluate the Higher Update Education Institutions (HEIs) in terms of quantity and quality of Faculty of Pharmacy (FOP) Update 26 research as well as quantity and quality of researchers. In order Crème de la crème : The Impact of Pharmacist-Initiated 32 to reach our aim of scoring two stars for this time around, the Interventions in Improving Acute Coronary Syndrome contribution and commitment of each and every member of CUCMS Secondary Prevention Pharmacotherapy Prescribing is essential. More about the roadshow and other events by CGSRC upon Discharge can be read in the CGSRC Highlights section. Last but not least, Crème de la crème : Discovery Of Bioactive Secondary 34 we have introduced a new section called One Minute Lesson Metabolites From The Leaves Of Vitex Pinnata And Metabolomics Of Its Endophytic Fungus, Nigrospora Sp which will highlights one short aspect relevant to research and publication. Crème de la crème : Extract of Carica papaya L. leaves: 35 Standardising its use in dengue fever New sections included in this issue include Lab Profile which will Lab Profile: Molecular Research Lab 36 feature one set of instruments available in our labs that can Personality focus: Mr Azhar Tajul Noor 38 be used for a particular process. For this time around the PCR workflow is highlighted. Another new section is #Library which will #Library 39 focus on (1) Services offered by Library, focusing on Turnitin for Research Poster 40 this issue and (2) Know Your Library, focusing on the Thesis Room. Postgraduate Column: International Conference & 42 Exhibition on Holistic Wellness (ICEHW) So much is in store for you in this issue, and we wish you Happy CGSRC Highlights 43 Reading! Mark Your Calendar 48 Dr Wan Rosalina Wan Rosli Editorial Board 48 Editor Disclaimer The views, opinions and commentaries expressed in the Re:Search Bulletin do not necessarily reflect those of the Editorial Board, Centre for Graduate Studies, Research & Commercialisation nor Cyberjaya University College of Medical Sciences (CUCMS) unless expressly stated. No part of this publication may be reproduced without the permission of CUCMS. Facts contained herewith are believed to be true as of the date that it is published. All content, materials, and intellectual property rights are owned and provided for by CUCMS and its members. CUCMS makes no guarantees or representations whatsoever regarding the information contained herewith including the truth of content, accuracy, safety, or the absence of infringement of rights of other parties. In no circumstances shall CUCMS be held liable for the contents, materials, advertisement contained in this publication. 2 From the horse’s mouth: RMU Update Updates from Mesyuarat Penyelarasan BPKI JPT Bersama RMC IPT Bil 2/2016 on 7th Disember 2016, held at the Ministry of Higher Education, Putrajaya. How Malaysia fared in World University Rankings Figure 1 Malaysia’s Research Landscape grows by 594% between 2005 – 2014 QS World & Asia University Ranking QS World Ranking has seen that nine Malaysian universities have made it to the top 700 with our research universities showing great potential with one new entry from Universiti Teknologi Petronas (UTP) ranking at 601 – 650. As for QS ASIA University Rankings 2016, five of our research universities made it to the top 100 cluster (top 1% Asia). Universiti Malaya & Universiti Putra Malaysia made it into the top 50 cluster. 3 University World University Ranking Asia Ranking 27 49 55 63 51 4 Areas of Strength for Malaysia – Top 200 according to QS Subject Ranking Mapping Areas Subject ≤ 50 Top 51 – 100 Top 101 – 150 Top 151 – 200 UM, UKM, Architecture/ Built Environment USM, UTM English Language & Literature UM UKM UPM, USM Arts & Humanities Linguistics UM UKM, USM UPM Modern Languages UM Agriculture & Forestry UPM UMS Biological Sciences USM Life Sciences & Medicine Medicine UM Pharmacy & Pharmacology USM UM UPM, UKM Computer Science & Information UM, USM UPM, UTM Systems UM, UKM, Eng – Chemical USM (46) UPM, UTP UTM Engineering & Eng – Electrical & Electronic UM (37) UTM, USM UPM, UKM MMU Technology Eng – Civil & Structural UM, UTM, USM UKM, UPM Eng – Mechanical, Aeronautical & UPM, UTM, UM, USM UTP Manufacturing UKM Chemistry UM, USM Environmental Sciences USM UM UPM, UTM Natural Geography & Area Studies UM Sciences UKM, UTM, Materials Science USM UPM, UM Mathematics USM UKM, UUM, Accounting & Finance UM, UPM UiTM Business & Management Studies UM, USM UPM, UKM Communication & Media Studies UM UKM, USM Development Studies UM (30) USM Social Sciences & Economics & Econometrics UM, USM, UPM Management UM, UKM, Education UPM UTM, UiTM USM Law UM Social Policy & Administration UKM Statistics & Operational Research UM, USM 5 Governmental Grants: Feedback from MOHE Ministry of Higher Education has concluded the grant cycles for 2016 that included Skim Geran Penyelidikan Jangka Panjang (LRGS), Skim Geran Penyelidikan Fundamental (FRGS), Skim Geran Penyelidikan Transdisiplinari (TRGS) and Skim Geran Penyelidikan Pembangunan Prototaip (PRGS). Analysis of the applications are as follows: FRGS PRGS TRGS LRGS Application 4486 301 116 24 Approved 1183 63 19 0 Funds Requested (RM) 650892815 67581816 124891026 210021351 Funds Approved (RM) 95749280 8175430 11624100 0 Issues during application of MOHE grants 2016 Quality of Proposals ◊ University’s own internal review panel Researcher profile in need to be more stringent. ◊ Requirements for application not MyGRANTS fulfilled - missing quotations, duration of applicant’s contract, track record of ◊ Researcher profiles are not updated research etc. (includes list of publication, IP, projects ◊ Proposals not improved based on and supervisions). feedback from internal panel review. ◊ Attachments could not be opened. ◊ Presentations that do not follow format ◊ Quotations not attached although by MOHE - researchers were unprepared. already mentioned in the Guidelines 6 7 HOT TOPICS: THERAPEUTIC OVER CLAIMS Weight loss herbal supplements: Boon or Bane? by Dr Reshma Mohamed Ansari, MBBS and Norfaizatul Shalida Omar, Ph.D The Dietary Supplement Health and Education Act (DSHEA) defines a dietary supplement as “a product (other than tobacco) that is intended to supplement the diet and that bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, an herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract or combinations of these ingredients” (Halsted, 2003). In the year 2000, more than half of the US population have been known to consume at least one dietary supplement (Halsted, 2003). Health supplements being “herbal” in nature are categorised as food products wherein pre-marketing approval is not as stringent as allopathic medications (Chen et al., 2010) are widely available in the market and can be purchased without prescription (Stickel, 2007). The majority of the herbal users do not feel it necessary to inform their physicians about the consumption of supplements (Singh & Prakash, 2008) even during pre-operative assessment (Halsted, 2003) and most of the physicians overlook this fact and seldom query the patients (Halsted, 2003). Figure 1: Types of Complementary and Alternative medicines used by US consumers (Tachjian et al. 2010) Herbal supplements for weight loss: Herbal body supplements can either be used for body-building or for non-body building purposes. Out of the supplements used for non-building purposes, weight loss stands as the most important reason to consume these supplements (Zheng & Navarro, 2010). The constant rise in obesity rates has triggered the weight loss supplement industry to boom as a billion-dollar industry. End-users of these supplements view them as an alternative method and deem them to be safe (Zheng & Navarro, 2010). In comparison with body-building supplements, consumers of weight loss supplements were almost twice as affected due to drug adverse reactions (Zheng & Navarro, 2010). Reports of toxicities encountered with these supplements: The U.S Drug induced Liver Injury Network (DILIN) has reported a dramatic increase in cases of liver injury in the past 10 years which is attributed to supplement intake (Zheng & Navarro, 2010). Felix Stickel in his editorial reports 2 cases of liver damage post intake of Herbalife supplements (Stickel, 2007). Hydoxycut weight loss products caused death due to cardiac and cerebrovascular accidents in young, otherwise healthy patients. Ephedra a component of this supplement was identified as the culprit (Stickel, 2007). Ephedra has serious circulatory and nervous system adverse effects such as increase in blood pressure, increase in heart rate leading to risk of arrhythmias and potent vasospasm (Halsted, 2003). It is also known to cause nephrolithiasis (kidney stones). The stones were composed of ephedrine, norephedrine, and pseudoephedrine (Gabardi et al., 2007). 8 Green tea (Camellia sinensis) though widely known for its antioxidant properties and weight loss potential (Patel et al., 2013), is also known to be hepatotoxic (Zheng & Navarro, 2010). Green tea extract is rich in polyphenols much greater than black tea which are further composed of catechins and flavanols. Catechins though boast of antioxidant benefits were also found to cause cytotoxicity by damaging the mitochondrial membrane and initiation of reactive oxygen species (ROS) formation. Another interesting point is that the catechins cause more damage while the consumers are fasting rather than in the fed stage. Since people who intend to lose weight also undergo a diet regimen, the adverse effects of catechins might be profound on them (Zheng & Navarro, 2010). Exolise, a weight loss supplement whose prime ingredient was Camellia sinensis was withdrawn from the market in France and Spain due to the varied reports received linking it to liver toxicity (Chen et al., 2010); Patel et al., 2013). Another ingredient, Garcinia cambogia is known for its ability to prevent the conversion of carbohydrates to fat has been widely linked to oxidative stress, hepatic fibrosis and inflammation (Patel et al., 2013). OEP supplements, contained a compound aegeline with anti-adipogenic features which was known to cause hepatocellular pattern of injury in the consumers (Zheng & Navarro, 2010). Chinese herbal supplements for weight loss contain Aristolochic acid which is notorious for causing urothelial carcinoma, renal intestinal fibrosis and loss of cortical nephrons (Gabardi et al., 2007; Singh & Prakash, 2008). In patients with cardiovascular diseases, garlic, ginger, grapefruit juice and green tea which are used for weight loss are known to have decreased effects of Warfarin, hypotension and liver toxicity respectively (Tachjian et al. 2010). Chromium picolinate (CP) widely used for its lipid lowering and weight loss properties is known to produce acute kidney failure resulting from acute tubular necrosis warranting haemodialysis (Gabardi et al., 2007). Patients with known conditions such as diabetes, hypertension or coronary artery disease might develop renal disease due to these supplements (Singh & Prakash, 2008). Possible reasons for the toxicities: The frightening aspect of these products is that the constituents are often not characterised, not included in labels and clear beneficial effects and their side effects are not stated. In addition, they are advertised massively to lure the lay consumers who fall prey in spite of the lack of scientific information (Stickel, 2007). The herbal supplements might contain toxic substances which could cause drug interactions (Halsted, 2003). Contamination of herbal products with hepatotoxic Bacillus cereus is also considered as a risk factor to develop liver injury. Moreover additives in the form of preservatives and flavour enhancers might be contaminated to produce serious side effects (Stickel, 2007). The unintentional contamination with pesticides, fertilizers and heavy metals may also cause serious liver toxicity in these consumers (Chen et al., 2010). Variation of constituents from batch to batch will also results in varied reactions among consumers (Singh & Prakash, 2008). What needs to be done? Most of the cases of supplement-induced toxicities go unnoticed due to laack of enforcement, scientific evidence and knowledge among health care providers and patients (Tachjian et al., 2010). With all the reports of toxicity, the companies that manufacture these supplements refuse to disclose the prime ingredients and detailed composition of their products (Stickel, 2007; Chen et al., 2010). Hence physicians are recommended to come up with a working knowledge of herbal products, their claims of efficacy, life-threatening toxicities and drug interactions to avoid untoward reactions in the patient. This also would enable them to counsel their patients accordingly (Zheng & Navarro, 2010). The government is urged to practise tight regulations against the herbal products to avoid untoward episodes of supplement-induced toxicity (Chen et al., 2010). References: Chen GC, Ramanathan VS, Law D, Funchain P, Chen GC, French S, Shlopov B, Eysselein V, Chung D, Reicher S and Pham BV. Acute liver injury induced by weight-loss herbal supplements. World Journal of Hepatology. 2010; 2 (11): 410-415. Gabardi S, Munz K and Ulbricht C. A Review of Dietary Supplement–Induced Renal Dysfunction. Clinical Journal of American Society of Nephrology. 2007; 2: 757–765. Halsted C. Dietary supplements and functional foods: 2 sides of a coin? American Journal of Clinical Nutrition. 2003; 77 (suppl):1001S–7S. Patel SS, Beer S, Kearney DL, Phillips G and Carter BA. Green tea extract: A potential cause of acute liver failure. World Journal of Gastroenterology. 2013; 19 (31):5174-5177. Singh NP and Prakash A. Herbal Drugs and Acute Renal Injury. Medicine update. 2008; 150-155. Stickel F. Slimming at all costs: Herbalife-induced liver injury. Journal of Hepatology. 2007; (47):444–446. Tachjian A, Maria V and Jahangir A. Use of Herbal Products and Potential Interactions in Patients with Cardiovascular Diseases. Journal of American College of Cardiology. 2010; 55(6):515–525. Zheng EX and Navarro VJ. Liver Injury from Herbal, Dietary, and Weight Loss Supplements: a Review. Journal of Clinical and Translational Hepatology.2015; 3:93–98. 9 Skin whitening products are not so fair and lovely after all By Phang Mun Yee If you take a stroll along the aisle in any personal care and cosmetic stores, high chance is that you will always stumble upon again and again tonnes of cosmetic care products that are labelled with skin-whitening effects. These products come in many names, such as “fair and lovely”, “skin whiteners”, “Skin lightening”, “fairness cream” etc. These products come with an awfully long and exhaustive list of chemical ingredients on their label, which chemicals are not easily understood as reading a food label. Unsurprisingly, the market for these skin whitening products is well supported and highly regarded by many women who desire for fair skin, as fair skin is equates to beauty. Swept in the waves of great adoration for white skin, we also see there are booms of certain unscrupulous parties that by sheer gullibility, cash in on this “skin whitening” craze by self-marketing and selling unregistered cosmetic products on electronic and social media, like Instagram, Facebook and social messaging apps. News of seized goods and premises raided are frequently reported. More recently, appalling news was reported on bogus, unqualified beauty practitioners that operate illegally in their house-turned beauty centre, providing beauty injections which they are not licensed for [1]. All cosmetic care products including the skin lightening products, must undergo product notification by the National Pharmaceutical Control Bureau (NPCB), which is tasked to ensure these products are safe prior to marketing. Most cosmetic products sold online however may easily evade the long arms of the law and may not be registered under the “control of Drugs and Cosmetics regulation”. These products sold unregulated could largely consist of scheduled drugs (drugs that are not allowed to be sold over the counter nor for retail sale due to potential of abuse), or adulterated with prohibited substances such as mercury, hydroquinone, tretinoin and azelaic acid [2, 3], which are prohibited in Malaysia. Products containing these prohibited substances, are no longer classified as cosmetics, but as pharmaceutical products. Thus, they must be registered with the Drug Control Authority (DCA). Usage of these products containing prohibited substances are only permitted with the condition that it is advised by healthcare professionals [2,3]. What give the skin its colour? How do these skin-whitening products work? In the human skin, cells that responsible for producing the skin pigment, melanin (two types: eumelanin and pheomelanin) are called melanocytes. Residing in the deepest layer of the epidermis (strata basale), melanocytes synthesis melanin from amino acid tyrosine which reaction is catalyse by the enzyme tyrosinase. Melanins are stored inside organelles called melanosomes, which are then transported via their dendrites to the keratinocytes located in the upper epidermal layers close to the skin surface. When the skin is exposed to UV radiation, melanocytes are stimulated to produce more melanin. Melanins play a crucial role in quenching free radicals and shielding the DNA from the damage caused by UV radiation [4]. Variation of skin colour is determined by the number and size of melanosome, the degree of melanin production and different rate of melanosome degradation. Dark-skinned individuals will have better melanin protection than light-skinned individuals. Most of the ingredients in the skin whitening products work as skin depigmenting agents, interfering at certain junctions in the melanogenesis pathway. Largely, skin depigmenting agents target the key enzyme tyrosinase, as competitive or non-competitive tyrosinase inhibitor interfere with the conversion of tyrosine to melanin. Compounds that have such mechanism of action are mercury, hydroquinone, arbutin, deoxyarbutin, kojic acid and azelaic acid [4]. The use of mercury, hydroquinone and azelaic acid was deemed unsafe and has been banned in many countries including ours. Mercury is implicated with potential nephrotoxicity, while hydroquinone is reported to be associated to ochronosis and exhibits melanocyte cytotoxicity, which lead to permanent depigmentation [2, 3, 4]. Azelaic acid may cause stinging and skin irritation [3]. Arbutin (compound found in cranberries, blueberries, wheats, pears) and deoxyarbutin (synthetically produced derivative of arbutin) are not toxic to melanocytes as in the case of hydroquinone. Kojic acid, a fungal metabolite derived from microorganism, species Acetobacter, Aspergilus and Penicillium interfere with the active site of the tyrosinase. Kojic acid has its own side effects, can cause contact dermatitis, sensitization and erythema [4]. 10