A Foreign Body Aspiration Leading to Pneumothorax: A Case of Airway Emergency.

Foreign body (FB) aspiration is a matter that should not be taken lightly. The presence of a foreign object might lead to hazardous complications, particularly in the pediatric population. These complications depend on the type and location of the aspirated object as the tracheobronchial tree has a very small diameter, and foreign bodies become stuck in the upper airways of children, causing stridor and sudden difficulty in breathing. Impaction of a foreign body in the right bronchial tree is more frequent due to the relatively straighter alignment of the right mainstem of the trachea, as opposed to the left side. Herein, we present a 10-year-old Malay boy who accidentally aspirated a pencil cap. An urgent computed tomography (CT) of the thorax revealed a suspicious intraluminal FB in the bronchus leading to pneumothorax and pneumomediastinum. He underwent a right bronchoscopy and a successful FB removal.

Video head impulse test in stroke: a review of published studies.

Accurate and timely diagnosis of posterior circulation stroke in patients with acute dizziness is a challenge that can lead to misdiagnosis and significant harm. The present review sought to identify and describe published research on the clinical application of vHIT in posterior circulation stroke. vHIT, a portable device, has gained prominence in evaluating peripheral vestibular disorders and offers potential applications in diagnosing neurological disorders, particularly posterior circulation stroke. Several studies have shown that vHIT can differentiate between stroke and vestibular neuritis based on VOR gain values, with high sensitivity and specificity. The manuscript also discusses vHIT's performance in differentiating between types of posterior circulation stroke, such as PICA, AICA, and SCA strokes. While vHIT has demonstrated promise, the review emphasizes the need for further research to validate its use as a tool to rule out stroke in acute dizziness patients in the emergency department. In conclusion, the manuscript underscores the potential of vHIT as a valuable addition to the diagnostic arsenal for acute dizziness, particularly in the context of posterior circulation stroke. It calls for further research and wider adoption of vHIT in clinical settings to improve patient care and reduce unnecessary costs associated with misdiagnoses.

A Case of an Uncommon Lower Lip Swelling.

A woman in her fifty-seventh year appeared with a painless swelling on her left lower lip that had been present for three years. The size of the swelling was noticeably increasing in size over time. On examination, there was a lump that was firm, non-tender, and measured 2 cm x 1 cm above the lower lip. The oral cavity, as well as the intraoral mucosa, were normal and unremarkable in appearance. As fine-needle aspiration cytology revealed a spindle cell lesion, she had an excision biopsy performed, followed by bilateral advancement flap closure. Histopathological examination (HPE) revealed a schwannoma in the tissue sample. Schwannomas are rare, benign neural tumors originating from Schwann cells. They are mainly asymptomatic and have a moderate rate of growth. Excision is the recommended treatment for schwannomas. Proper surgical planning and postoperative monitoring are crucial for optimal wound healing and complete recovery.

The public health response to a Plasmodium malariae outbreak in Penampang district, Sabah during a COVID-19 movement control order.

BACKGROUND: Since 2018, no indigenous human malaria cases has been reported in Malaysia. However, during the recent COVID-19 pandemic the World Health Organization is concerned that the pandemic might erode the success of malaria control as there are reports of increase malaria cases in resource limited countries. Little is known how the COVID-19 pandemic has impacted malaria in middle-income countries like Malaysia. Here the public health response to a Plasmodium malariae outbreak occurred in a village in Sabah state, Malaysia, during a COVID-19 movement control order is reported. METHODS: An outbreak was declared following the detection of P. malariae in July 2020 and active case detection for malaria was performed by collecting blood samples from residents residing within 2 km radius of Moyog village. Vector prevalence and the efficacy of residual insecticides were determined. Health awareness programmes were implemented to prevent future outbreaks. A survey was conducted among villagers to understand risk behaviour and beliefs concerning malaria. RESULTS: A total of 5254 blood samples collected from 19 villages. Among them, 19 P. malariae cases were identified, including the index case, which originated from a man who returned from Indonesia. His return from Indonesia and healthcare facilities visit coincided with the movement control order during COVID-19 pandemic when the healthcare facilities stretched its capacity and only serious cases were given priority. Despite the index case being a returnee from a malaria endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities. All cases were symptomatic and uncomplicated except for a pregnant woman with severe malaria. There were no deaths; all patients recovered following treatment with artemether-lumefantrine combination therapy. Anopheles balabacensis and Anopheles barbirostris were detected in ponds, puddles and riverbeds. The survey revealed that fishing and hunting during night, and self-treatment for mild symptoms contributed to the outbreak. Despite the index case being a returnee from a malaria-endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities. CONCLUSION: The outbreak occurred during a COVID-19 movement control order, which strained healthcare facilities, prioritizing only serious cases. Healthcare workers need to be more aware of the risk of malaria from individuals who return from malaria endemic areas. To achieve malaria elimination and prevention of disease reintroduction, new strategies that include multisectoral agencies and active community participation are essential for a more sustainable malaria control programme.

Establishing a hyperacute stroke service during the COVID-19 pandemic: our institution's one year experience.

BACKGROUND AND AIMS: The corononavirus 2019 (COVID-19) pandemic resulted in modifications in the workflow and redistribution of human resources, causing challenges in setting up of an acute stroke service. We would like to share our preliminary outcome amid this pandemic, to determine if the implementation of COVID-19 standard operating procedures (SOPs) affected the delivery of our hyperacute stroke service. METHODS: We retrospectively analyzed one-year data from our stroke registry that began with the establishment of our hyperacute stroke service at Universiti Putra Malaysia Teaching Hospital from April 2020 until May 2021. RESULTS: Setting up acute stroke services during the pandemic with constrained manpower and implementation of COVID-19 SOPs, was challenging. There was a significant dip of stroke admission from April to June 2020 due to the Movement Control Order (MCO) implemented by the government to curb the spread of COVID-19. However, the numbers of stroke admission steadily rose approaching 2021, after the implementation of recovery MCO. We managed to treat 75 patients with hyperacute stroke interventions i.e. intravenous thrombolysis (IVT), mechanical thrombectomy (MT) or both. Despite implementing COVID-19 SOPs and using magnetic resonance imaging (MRI) as our first line acute stroke imaging modality, clinical outcomes in our cohort were encouraging; almost 40% of patients who underwent hyperacute stroke treatment had early neurological recovery (ENR), and only 33% of patients had early neurological stability (ENS). In addition, we were able to maintain our door-to-imaging (DTI) and door-to-needle (DTN) time in line with international recommendations. CONCLUSIONS: Our data reflects that COVID-19 SOPs did not deter successful delivery of hyperacute stroke services in our center. However, bigger and multi center studies are required to support our findings.

A Red Flag: A Case of Oropharyngeal Cancer Masquerading as an Ulcer of an Infective Origin.

Oropharyngeal squamous cell carcinoma is a prevalent neoplastic condition. The incidence rate in Malaysia is rising, with human papillomavirus (HPV) infection being recognized as a significant contributing factor. Hence, it is paramount for physicians to effectively diagnose and identify significant indicators that may indicate a malignant etiology. In this study, we present a case of a middle-aged Malay male who presented with the primary symptom of persistent right throat discomfort for one month. The preliminary presentation, blood parameters, and initial histopathological examination (HPE) findings indicate the presence of an infection. However, despite undergoing several medical treatments, the patient's symptoms remain, albeit with only minor clinical improvement. Subsequently, the patient underwent a biopsy under general anesthesia, which subsequently yielded a report indicating the presence of oropharyngeal squamous cell carcinoma with a negative p16 status. Therefore, it is imperative for clinicians to possess knowledge of warning flags and exercise vigilance when encountering a patient who fails to respond despite thorough and precise evaluation. If there is a strong suspicion of malignancy, it is imperative to do a comprehensive clinical investigation and regular monitoring.

Human epidermal growth factor receptor 2 (HER2)-specific chimeric antigen receptor (CAR) for tumor immunotherapy; recent progress.

Due to the overexpression or amplification of human epidermal growth factor receptor 2 (HER2) with poor prognosis in a myriad of human tumors, recent studies have focused on HER2-targeted therapies. Deregulation in HER2 signaling pathways is accompanied by sustained tumor cells growth concomitant with their migration and also tumor angiogenesis and metastasis by stimulation of proliferation of a network of blood vessels. A large number of studies have provided clear evidence that the emerging HER2-directed treatments could be the outcome of patients suffering from HER2 positive breast and also gastric/gastroesophageal cancers. Thanks to its great anti-tumor competence, immunotherapy using HER2-specific chimeric antigen receptor (CAR) expressing immune cell has recently attracted increasing attention. Human T cells and also natural killer (NK) cells can largely be found in the tumor microenvironment, mainly contributing to the tumor immune surveillance. Such properties make them perfect candidate for genetically modification to express constructed CARs. Herein, we will describe the potential targets of the HER2 signaling in tumor cells to clarify HER2-mediated tumorigenesis and also discuss recent findings respecting the HER2-specific CAR-expressing immune cells (CAR T and CAR NK cell) for the treatment of HER2-expressing tumors.

COVID-19 pandemic: determinants of workplace preventive practice among primary healthcare workers in Sabah, Malaysia.

INTRODUCTION: COVID-19 pandemic has placed the entire world, including Malaysia in a state of fear. The rising burden on healthcare facilities has put healthcare workers consistently at risk of healthcare-associated infection. We sought to identify determinants of preventive practice against COVID-19 at work among primary healthcare professionals in Sabah, Malaysia. METHOD: This was a cross-sectional study involving healthcare workers of the Penampang and Putatan districts of Sabah, Malaysia. A total of 167 health professionals from primary healthcare settings took part in this study via a self-administered questionnaire from November 2020 until January 2021. Independent t-test and Analysis of Variance were used to determine differences in preventive practice for categorical independent variables. Pearson product-moment correlation was applied to assess the relationship between Job Satisfaction, burnout, and preventive practice. Subsequently, predictors of preventive practice at work among healthcare workers in Sabah were identified through Binomial Logistic Regression. RESULTS: The prevalence of good preventive practice among health professionals at work was 71.3%. There was no difference in preventive practice between professions. Almost all participants reported having good personal protective equipment compliance and hand hygiene practice at work. Marital status (AOR = 4.170, 95% CI = 1.787, 9.733; p = 0.001), average sleep hours (AOR = 1.775, 95% CI = 1.144, 2.754; p = 0.01), and pandemic-related burnout (AOR = 0.905, 95% CI = 0.847, 0.967; p = 0.003) were identified as significant predictors of preventive practice at primary healthcare facilities. CONCLUSIONS: The outcome of this study is beneficial to the healthcare organization. It can serve as a useful guide to tackle issues related to poor preventive practice against COVID-19 at work for health professionals.

Malaria Cases in a Tertiary Hospital in Kuala Lumpur, Malaysia: A 16-Year (2005-2020) Retrospective Review.

While there has been a tremendous decline in malaria disease burden in the remote parts of Malaysia, little is known about malaria incidence in its urban localities. This study aimed to analyze trends of malaria cases in urban Kuala Lumpur, Malaysia. All suspected cases presented to a university hospital in Kuala Lumpur from January 2005 to December 2020 were examined by microscopy. Infection status was analyzed using descriptive statistics and curve estimation analysis. Of 3105 blood films examined, 92 (3%) were microscopically confirmed malaria cases. Plasmodium vivax infections accounted for the majority (36.9%) of all malaria cases. Nearly half (47.8%) of cases were found among foreign cases (p < 0.001). The majority of foreign cases were male (86.4%) and came from Southeast Asian countries (65.9%). The curve estimation analysis showed significant decreases in malaria cases due to P. vivax (R2 = 0.598; p < 0.001) and Plasmodium falciparum (R2 = 0.298, p = 0.029), but increases for Plasmodium knowlesi (R2 = 0.325, p = 0.021) during the 16 years. This study showed that malaria incidence in urban Kuala Lumpur is low and has remained stable since 2005. However, P. knowlesi has played a significant role in the increase in overall malaria in the area, highlighting the importance of continued vigilance and improved surveillance.

MR imaging of hypothalamic hamartoma in a patient with gelastic seizures.

Hypothalamic hamartomas (HHs) are non-neoplastic malformations that occur in the region of the hypothalamus. HH is the leading cause of gelastic seizures in children and adolescents, where laughing is characteristically manifested. However, these patients can also experience different forms of complex or generalized tonic-clonic seizures that can obscure the diagnosis of HHs. We present a case of a 10 year-old boy that experienced several seizure types, but was subsequently diagnosed with HH after MR imaging was performed. This case highlights the complementary role of MR imaging in ascertaining seizure etiololgy when the clinical history and EEG findings are non-specific. The importance of early diagnosis with MR imaging is further underscored by the fact that patients diagnosed with HH usually develop drug resistance towards antiepileptic drugs, mandating neurosurgical assessment and intervention.

Doctors' Mental Health in the Midst of COVID-19 Pandemic: The Roles of Work Demands and Recovery Experiences.

The COVID-19 pandemic potentially increases doctors' work demands and limits their recovery opportunity; this consequently puts them at a high risk of adverse mental health impacts. This study aims to estimate the level of doctors' fatigue, recovery, depression, anxiety, and stress, and exploring their association with work demands and recovery experiences. This was a cross-sectional study among all medical doctors working at all government health facilities in Selangor, Malaysia. Data were collected in May 2020 immediately following the COVID-19 contagion peak in Malaysia by using self-reported questionnaires through an online medium. The total participants were 1050 doctors. The majority of participants were non-resident non-specialist medical officers (55.7%) and work in the hospital setting (76.3%). The highest magnitude of work demands was mental demand (M = 7.54, SD = 1.998) while the lowest magnitude of recovery experiences was detachment (M = 9.22, SD = 5.043). Participants reported a higher acute fatigue level (M = 63.33, SD = 19.025) than chronic fatigue (M = 49.37, SD = 24.473) and intershift recovery (M = 49.97, SD = 19.480). The majority of them had no depression (69.0%), no anxiety (70.3%), and no stress (76.5%). Higher work demands and lower recovery experiences were generally associated with adverse mental health. For instance, emotional demands were positively associated with acute fatigue (adj. b = 2.73), chronic fatigue (adj. b = 3.64), depression (adj. b = 0.57), anxiety (adj. b = 0.47), and stress (adj. b = 0.64), while relaxation experiences were negatively associated with acute fatigue (adj. b = -0.53), chronic fatigue (adj. b = -0.53), depression (adj. b = -0.14), anxiety (adj. b = -0.11), and stress (adj. b = -0.15). However, higher detachment experience was associated with multiple mental health parameters in the opposite of the expected direction such as higher level of chronic fatigue (adj. b = 0.74), depression (adj. b = 0.15), anxiety (adj. b = 0.11), and stress (adj. b = 0.11), and lower level of intershift recovery (adj. b = -0.21). In conclusion, work demands generally worsen, while recovery experiences protect mental health during the COVID-19 pandemic with the caveat of the role of detachment experiences.

Bronchopulmonary lophomoniasis: A rare cause of pneumonia in an immunosuppressed host.

Bronchopulmonary lophomoniasis is rare but immunocompromised individual is susceptible to this infection. We reported a case of bronchopulmonary lophomoniasis in a Malaysian female with systemic lupus erythromatosus. She presented with productive cough, shortness of breath and high-grade fever for 2 weeks. Physical examination revealed bronchial sound and crackles over the left lung with, reduced expansion and dull percussion in lower left lobe. Chest radiography showed consolidation of the left lung. Routine laboratory tests revealed general low cell count. Blood and sputum culture were negative. Bronchoalveolar lavage stain and culture for bacterial and fungal were negative. Bronchoalveolar lavage for Lophomonas blattarum was positive. Patient was treated with antiprotozoal drug, metronidazole. All her clinical problems resolved and she was discharged 14 days after admission.

Discovery of new depigmenting compounds and their efficacy to treat hyperpigmentation: Evidence from in vitro study.

Human skin pigmentation is a result of constitutive and facultative pigmentation. Facultative pigmentation is frequently stimulated by UV radiation, pharmacologic drugs, and hormones whereby leads to the development of abnormal skin hyperpigmentation. To date, many state-of-art depigmenting compounds have been studied using in vitro model to treat hyperpigmentation problems for cosmetic dermatological applications; little attention has been made to compare the effectiveness of these depigmenting compounds and their mode of actions. In this present article, new and recent depigmenting compounds, their melanogenic pathway targets, and modes of action are reviewed. This article compares the effectiveness of these new depigmenting compounds to modulate several melanogenesis-regulatory enzymes and proteins such as tyrosinase (TYR), TYR-related protein-1 (TRP1), TYR-related protein-2 (TRP2), microphthalmia-associated transcription factor (MITF), extracellular signal-regulated kinase (ERK) and N-terminal kinases (JNK) and mitogen-activated protein kinase p38 (p38 MAPK). Other evidences from in vitro assays such as inhibition on melanosomal transfer, proteasomes, nitric oxide, and inflammation-induced melanogenesis are also highlighted. This article also reviews analytical techniques in different assays performed using in vitro model as well as their advantages and limitations. This article also provides an insight on recent finding and re-examination of some protocols as well as their effectiveness and reliability in the evaluation of depigmenting compounds. Evidence and support from related patents are also incorporated in this present article to give an overview on current patented technology, latest trends, and intellectual values of some depigmenting compounds and protocols, which are rarely highlighted in the literatures.

A comparison of different types of ovitraps for outdoor monitoring of Aedes mosquitoes in Kuala Lumpur.

Dengue is a significant public health problem in Malaysia and vector surveillance is one of the important components in a vector control program. Routinely vector surveillance in Malaysia is performed through larval surveys. However, larval surveys have several limitations. Thus ovitraps are used as an alternative method for monitoring dengue vectors. The aim of this study was to determine the effectiveness of Standard Ovitrap (SO), Mosquito larvae Trapping Device (MLTD), Double Sticky Ovitrap (DST) and NPK Fertiliser Trap to monitor the abundance of Aedes mosquitoes. Each ovitrap was placed at four different sampling points and rotated to the next position every one week. Larvae and adult mosquitoes were collected and identified in the laboratory. All four trapping methods successfully collected larvae of Aedes mosquitoes. The mean number of larvae per ovitrap in DST was significantly higher (p < 0.05) compared to SO and MLTD. DST and NPK Fertiliser Trap were capable of capturing adult mosquitoes. Ovitrap Index and the mean number of adults per ovitrap in NPK Fertiliser trap were significantly higher (p < 0.05) as compared to DST. Another set of experiments were conducted to compare NPK Fertiliser traps containing fresh NPK fertiliser solution with those containing stock NPK Fertiliser solution. The fresh solution was prepared fresh while the stock solution was stored for a month before being used in the field. Result shows no significant differences (p > 0.05) between these solutions. Findings from this study conclude that DST is the most effective ovitrap to monitor Aedes larvae, while NPK Fertiliser trap is the most effective ovitrap to trap Aedes adult mosquitoes in the study area.

A comparison of different types of ovitraps for outdoor monitoring of Aedes mosquitoes in Kuala Lumpur

@#Dengue is a significant public health problem in Malaysia and vector surveillance is one of the important components in a vector control program. Routinely vector surveillance in Malaysia is performed through larval surveys. However, larval surveys have several limitations. Thus ovitraps are used as an alternative method for monitoring dengue vectors. The aim of this study was to determine the effectiveness of Standard Ovitrap (SO), Mosquito larvae Trapping Device (MLTD), Double Sticky Ovitrap (DST) and NPK Fertiliser Trap to monitor the abundance of Aedes mosquitoes. Each ovitrap was placed at four different sampling points and rotated to the next position every one week. Larvae and adult mosquitoes were collected and identified in the laboratory. All four trapping methods successfully collected larvae of Aedes mosquitoes. The mean number of larvae per ovitrap in DST was significantly higher (p < 0.05) compared to SO and MLTD. DST and NPK Fertiliser Trap were capable of capturing adult mosquitoes. Ovitrap Index and the mean number of adults per ovitrap in NPK Fertiliser trap were significantly higher (p < 0.05) as compared to DST. Another set of experiments were conducted to compare NPK Fertiliser traps containing fresh NPK fertiliser solution with those containing stock NPK Fertiliser solution. The fresh solution was prepared fresh while the stock solution was stored for a month before being used in the field. Result shows no significant differences (p > 0.05) between these solutions. Findings from this study conclude that DST is the most effective ovitrap to monitor Aedes larvae, while NPK Fertiliser trap is the most effective ovitrap to trap Aedes adult mosquitoes in the study area.

A Zebrafish Embryo as an Animal Model for the Treatment of Hyperpigmentation in Cosmetic Dermatology Medicine.

For years, clinical studies involving human volunteers and several known pre-clinical in vivo models (i.e., mice, guinea pigs) have demonstrated their reliability in evaluating the effectiveness of a number of depigmenting agents. Although these models have great advantages, they also suffer from several drawbacks, especially involving ethical issues regarding experimentation. At present, a new depigmenting model using zebrafish has been proposed and demonstrated. The application of this model for screening and studying the depigmenting activity of many bioactive compounds has been given great attention in genetics, medicinal chemistry and even the cosmetic industry. Depigmenting studies using this model have been recognized as noteworthy approaches to investigating the antimelanogenic activity of bioactive compounds in vivo. This article details the current knowledge of zebrafish pigmentation and its reliability as a model for the screening and development of depigmenting agents. Several methods to quantify the antimelanogenic activity of bioactive compounds in this model, such as phenotype-based screening, melanin content, tyrosinase inhibitory activity, other related proteins and transcription genes, are reviewed. Depigmenting activity of several bioactive compounds which have been reported towards this model are compared in terms of their molecular structure and possible mode of actions. This includes patented materials with regard to the application of zebrafish as a depigmenting model, in order to give an insight of its intellectual value. At the end of this article, some limitations are highlighted and several recommendations are suggested for improvement of future studies.

Optimization of process parameters in preparation of tocotrienol-rich red palm oil-based nanoemulsion stabilized by Tween80-Span 80 using response surface methodology.

Red palm oil (RPO) is a natural source of Vitamin E (70-80% tocotrienol). It is a potent natural antioxidant that can be used in skin-care products. Its antioxidant property protects skin from inflammation and aging. In our work, a tocotrienol-rich RPO-based nanoemulsion formulation was optimized using response surface methodology (RSM) and formulated using high pressure homogenizer. Effect of the concentration of three independent variables [surfactant (5-15 wt%), co-solvent (10-30 wt%) and homogenization pressure (500-700 bar)] toward two response variables (droplet size, polydispersity index) was studied using central composite design (CCD) coupled to RSM. RSM analysis showed that the experimental data could be fitted into a second-order polynomial model and the coefficients of multiple determination (R2) is 0.9115. The optimized formulation of RPO-based nanoemulsion consisted of 6.09 wt% mixed surfactant [Tween 80/Span 80 (63:37, wt)], 20 wt% glycerol as a co-solvent via homogenization pressure (500 bar). The optimized tocotrienol-rich RPO-based nanoemulsion response values for droplet size and polydispersity index were 119.49nm and 0.286, respectively. The actual values of the formulated nanoemulsion were in good agreement with the predicted values obtained from RSM, thus the optimized compositions have the potential to be used as a nanoemulsion for cosmetic formulations.

Realm of Thermoalkaline Lipases in Bioprocess Commodities.

For decades, microbial lipases are notably used as biocatalysts and efficiently catalyze various processes in many important industries. Biocatalysts are less corrosive to industrial equipment and due to their substrate specificity and regioselectivity they produced less harmful waste which promotes environmental sustainability. At present, thermostable and alkaline tolerant lipases have gained enormous interest as biocatalyst due to their stability and robustness under high temperature and alkaline environment operation. Several characteristics of the thermostable and alkaline tolerant lipases are discussed. Their molecular weight and resistance towards a range of temperature, pH, metal, and surfactants are compared. Their industrial applications in biodiesel, biodetergents, biodegreasing, and other types of bioconversions are also described. This review also discusses the advance of fermentation process for thermostable and alkaline tolerant lipases production focusing on the process development in microorganism selection and strain improvement, culture medium optimization via several optimization techniques (i.e., one-factor-at-a-time, surface response methodology, and artificial neural network), and other fermentation parameters (i.e., inoculums size, temperature, pH, agitation rate, dissolved oxygen tension (DOT), and aeration rate). Two common fermentation techniques for thermostable and alkaline tolerant lipases production which are solid-state and submerged fermentation methods are compared and discussed. Recent optimization approaches using evolutionary algorithms (i.e., Genetic Algorithm, Differential Evolution, and Particle Swarm Optimization) are also highlighted in this article.

Kinetics and Optimization of Lipophilic Kojic Acid Derivative Synthesis in Polar Aprotic Solvent Using Lipozyme RMIM and Its Rheological Study.

The synthesis of kojic acid derivative (KAD) from kojic and palmitic acid (C16:0) in the presence of immobilized lipase from Rhizomucor miehei (commercially known as Lipozyme RMIM), was studied using a shake flask system. Kojic acid is a polyfunctional heterocycles that acts as a source of nucleophile in this reaction allowing the formation of a lipophilic KAD. In this study, the source of biocatalyst, Lipozyme RMIM, was derived from the lipase of Rhizomucor miehei immobilized on weak anion exchange macro-porous Duolite ES 562 by the adsorption technique. The effects of solvents, enzyme loading, reaction temperature, and substrate molar ratio on the reaction rate were investigated. In one-factor-at-a-time (OFAT) experiments, a high reaction rate (30.6 × 10-3 M·min-1) of KAD synthesis was recorded using acetone, enzyme loading of 1.25% (w/v), reaction time of 12 h, temperature of 50 °C and substrate molar ratio of 5:1. Thereafter, a yield of KAD synthesis was optimized via the response surface methodology (RSM) whereby the optimized molar ratio (fatty acid: kojic acid), enzyme loading, reaction temperature and reaction time were 6.74, 1.97% (w/v), 45.9 °C, and 20 h respectively, giving a high yield of KAD (64.47%). This condition was reevaluated in a 0.5 L stirred tank reactor (STR) where the agitation effects of two impellers; Rushton turbine (RT) and pitch-blade turbine (PBT), were investigated. In the STR, a very high yield of KAD synthesis (84.12%) was achieved using RT at 250 rpm, which was higher than the shake flask, thus indicating better mixing quality in STR. In a rheological study, a pseudoplastic behavior of KAD mixture was proposed for potential application in lotion formulation.