Browse publications by year: 2012

  1. Ahmad WA, Fong AY, Quek DK, Sim KH, Zambahari R
    Eur Heart J, 2012 Jan;33(2):155-6.
    PMID: 22351968
    MeSH terms: Cardiology/organization & administration*; Health Services/supply & distribution; Health Services Accessibility; Heart Diseases/therapy*; Humans; Interprofessional Relations; Malaysia
  2. Ng EK, Goh BL, Chew SE, Tan CC, Ching CH, Sha'ariah MY, et al.
    Semin Dial, 2012 Sep-Oct;25(5):569-73.
    PMID: 22353629 DOI: 10.1111/j.1525-139X.2012.01051.x
    The demands for timely catheter insertion have spurred the growth of peritoneoscopic catheter insertion program by nephrologists in Malaysia. We performed a multicenter analysis to study its impact on the growth of peritoneal dialysis (PD) population. Data were collected retrospectively from five centers at the point of program initiation until December 2009. In Center 1, with this program, PD population continued to grow from 25 patients in 2006 to 120 in 2009. In center 2, the program began in 2005, but comprised only 28.6% of total insertions. From 2007 onwards, nephrologists had overtaken the surgeon, inserting from 85% to 97% of the total insertions. In center 3, with the program at its infancy, a modest growth in its PD population was shown. In center 4, nephrologists maintained an annual average of 41.8% of total catheter insertions, and thus maintaining a stable PD population. In center 5, surgeon-assisted PD catheter insertions helped to maintain the growth of its PD, seeing lesser impact from this program. Subanalysis showed that 1-year catheter survival in Center 1 was 85.4%. This study on PD catheter insertion program by nephrologists showed the greatest impact on new center and center experiencing suboptimal catheter insertions by traditional providers.
    MeSH terms: Catheterization/methods*; Female; Humans; Kidney Failure, Chronic/epidemiology; Kidney Failure, Chronic/therapy*; Malaysia/epidemiology; Male; Middle Aged; Peritoneal Dialysis/instrumentation*; Practice Patterns, Physicians'/statistics & numerical data*; Survival Analysis; Treatment Outcome
  3. Lim CP, Loo AV, Khaw KW, Sthaneshwar P, Khang TF, Hassan M, et al.
    Br J Ophthalmol, 2012 May;96(5):704-7.
    PMID: 22353698 DOI: 10.1136/bjophthalmol-2011-301044
    To compare homocysteine (Hcy) concentration in the blood plasma, vitreous and aqueous of eyes with proliferative diabetic retinopathy (PDR) against control, and to investigate associations between Hcy concentration in blood plasma with that of aqueous and vitreous in these two groups.
    MeSH terms: Adult; Aged; Aqueous Humor/metabolism*; Diabetic Retinopathy/blood*; Female; Homocysteine/blood*; Humans; Hypercholesterolemia/blood; Hypertension/blood; Kidney Diseases/blood; Luminescent Measurements; Male; Middle Aged; Vitreous Body/metabolism*; Case-Control Studies; Myocardial Ischemia/blood; Stroke/blood
  4. Kamada T, Vairappan CS
    Molecules, 2012 Feb 21;17(2):2119-25.
    PMID: 22354189 DOI: 10.3390/molecules17022119
    Six populations of Laurencia nangii were found to produce three bromoallenes; dihydroitomanallene B (1), itomanallene B (2) and pannosallene (3). Prior to this report, L. nangii were only known to produce C(15)-acetogenins with acetylene functionality. This could be regarded as a new chemical race of L. nangii. The compound structures were elucidated on the basis of spectroscopic analysis and comparison with those previously reported in literature. Compound 1, dihydroitomanallene B, was isolated as a new compound representing a minor variation of itomanallene B (2).
    MeSH terms: Heterocyclic Compounds, 2-Ring/metabolism; Heterocyclic Compounds, 2-Ring/chemistry; Spectrum Analysis/methods; Laurencia/metabolism; Laurencia/chemistry*
  5. Yap BK, Buckle MJ, Doughty SW
    J Mol Model, 2012 Aug;18(8):3639-55.
    PMID: 22354276 DOI: 10.1007/s00894-012-1368-5
    5-HT(1A) serotonin and D1 dopamine receptor agonists have been postulated to be able to improve negative and cognitive impairment symptoms of schizophrenia, while partial agonists and antagonists of the D2 and 5-HT(2A) receptors have been reported to be effective in reducing positive symptoms. There is therefore a need for well-defined homology models for the design of more selective antipsychotic agents, since no three-dimensional (3D) crystal structures of these receptors are currently available. In this study, homology models were built based on the high-resolution crystal structure of the β(2)-adrenergic receptor (2RH1) and further refined via molecular dynamics simulations in a 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC) lipid bilayer system with the GROMOS96 53A6 united atom force field. Docking evaluations with representative agonists and antagonists using AutoDock 4.2 revealed binding modes in agreement with experimentally determined site-directed mutagenesis data and significant correlations between the computed and experimental pK (i) values. The models are also able to distinguish between antipsychotic agents with different selectivities and binding affinities for the four receptors, as well as to differentiate active compounds from decoys. Hence, these human 5-HT(1A), 5-HT(2A), D1 and D2 receptor homology models are capable of predicting the activities of novel ligands, and can be used as 3D templates for antipsychotic drug design and discovery.
    MeSH terms: Binding Sites; Dopamine/chemistry; Humans; Hydrogen Bonding; Models, Molecular*; ROC Curve; Serotonin/chemistry; Receptors, Dopamine D1/chemistry*; Receptors, Dopamine D2/chemistry*; Dopamine Antagonists/chemistry; Area Under Curve; Structural Homology, Protein; Receptor, Serotonin, 5-HT1A/chemistry*; Receptor, Serotonin, 5-HT2A/chemistry*; Molecular Dynamics Simulation*; Serotonin 5-HT1 Receptor Antagonists/chemistry; Serotonin 5-HT2 Receptor Antagonists/chemistry
  6. Yam H, Abdul Rahim A, Gim Luan O, Samian R, Abdul Manaf U, Mohamad S, et al.
    Protein J, 2012 Mar;31(3):246-9.
    PMID: 22354666 DOI: 10.1007/s10930-012-9398-5
    In this post genomic era, there are a great number of in silico annotated hypothetical genes. However, experimental validation of the functionality of these genes remains tentative. Two of the major challenges faced by researcher are whether these hypothetical genes are protein-coding genes and whether their corresponding predicted translational start codons are correct. In this report, we demonstrate a convenient procedure to validate the presence of a hypothetical gene product of BPSS1356 from Burkholderia pseudomallei as well as its start codon. It was done by integration of a His-Tag coding sequence into C-terminal end of BPSS1356 gene via homologous recombination. We then purified the native protein using affinity chromatography. The genuine start codon of BPSS1356 was then determined by protein N-terminal sequencing.
    MeSH terms: Bacterial Proteins/genetics; Bacterial Proteins/isolation & purification; Bacterial Proteins/metabolism*; Chromatography, Affinity; Cloning, Molecular/methods; Histidine/genetics; Recombinant Proteins/genetics; Recombinant Proteins/isolation & purification; Recombinant Proteins/metabolism; Reproducibility of Results; Burkholderia pseudomallei/genetics*; Burkholderia pseudomallei/metabolism; Codon, Initiator*
  7. Hamid AA, Idrus RB, Saim AB, Sathappan S, Chua KH
    Clinics (Sao Paulo), 2012;67(2):99-106.
    PMID: 22358233
    OBJECTIVES: Understanding the changes in chondrogenic gene expression that are involved in the differentiation of human adipose-derived stem cells to chondrogenic cells is important prior to using this approach for cartilage repair. The aims of the study were to characterize human adipose-derived stem cells and to examine chondrogenic gene expression after one, two, and three weeks of induction.

    MATERIALS AND METHODS: Human adipose-derived stem cells at passage 4 were evaluated by flow cytometry to examine the expression of surface markers. These adipose-derived stem cells were tested for adipogenic and osteogenic differentiation capacity. Ribonucleic acid was extracted from the cells for quantitative polymerase chain reaction analysis to determine the expression levels of chondrogenic genes after chondrogenic induction.

    RESULTS: Human adipose-derived stem cells were strongly positive for the mesenchymal markers CD90, CD73, CD44, CD9, and histocompatibility antigen and successfully differentiated into adipogenic and osteogenic lineages. The human adipose-derived stem cells aggregated and formed a dense matrix after chondrogenic induction. The expression of chondrogenic genes (collagen type II, aggrecan core protein, collagen type XI, COMP, and ELASTIN) was significantly higher after the first week of induction. However, a significantly elevated expression of collagen type X was observed after three weeks of chondrogenic induction.

    CONCLUSION: Human adipose-derived stem cells retain stem cell characteristics after expansion in culture to passage 4 and serve as a feasible source of cells for cartilage regeneration. Chondrogenesis in human adipose-derived stem cells was most prominent after one week of chondrogenic induction.

    MeSH terms: Adipose Tissue/cytology*; Cartilage, Articular/cytology*; Cell Differentiation/genetics*; Cells, Cultured; Collagen/genetics; Collagen/metabolism*; Elastin/genetics; Elastin/metabolism; Flow Cytometry; Gene Expression Regulation; Humans; Osteogenesis/genetics; RNA, Messenger/genetics; Time Factors; Biomarkers/metabolism; Chondrocytes/cytology; Chondrocytes/metabolism*; Chondrogenesis/genetics*; Adipogenesis/genetics; SOX9 Transcription Factor/genetics; SOX9 Transcription Factor/metabolism; Mesenchymal Stromal Cells/cytology; Mesenchymal Stromal Cells/metabolism*
  8. Makpol S, Zainuddin A, Chua KH, Yusof YA, Ngah WZ
    Clinics (Sao Paulo), 2012;67(2):135-43.
    PMID: 22358238
    OBJECTIVE: Human diploid fibroblasts undergo a limited number of cellular divisions in culture and progressively reach a state of irreversible growth arrest, a process termed cellular aging. The beneficial effects of vitamin E in aging have been established, but studies to determine the mechanisms of these effects are ongoing. This study determined the molecular mechanism of γ-tocotrienol, a vitamin E homolog, in the prevention of cellular aging in human diploid fibroblasts using the expression of senescence-associated genes.

    METHODS: Primary cultures of young, pre-senescent, and senescent fibroblast cells were incubated with γ-tocotrienol for 24 h. The expression levels of ELN, COL1A1, MMP1, CCND1, RB1, and IL6 genes were determined using the quantitative real-time polymerase chain reaction. Cell cycle profiles were determined using a FACSCalibur Flow Cytometer.

    RESULTS: The cell cycle was arrested in the G(0)/G(1) phase, and the percentage of cells in S phase decreased with senescence. CCND1, RB1, MMP1, and IL6 were upregulated in senescent fibroblasts. A similar upregulation was not observed in young cells. Incubation with γ-tocotrienol decreased CCND1 and RB1 expression in senescent fibroblasts, decreased cell populations in the G(0)/G(1) phase and increased cell populations in the G(2)/M phase. γ-Tocotrienol treatment also upregulated ELN and COL1A1 and downregulated MMP1 and IL6 expression in young and senescent fibroblasts.

    CONCLUSION: γ-Tocotrienol prevented cellular aging in human diploid fibroblasts, which was indicated by the modulation of the cell cycle profile and senescence-associated gene expression.

    MeSH terms: Analysis of Variance; Antioxidants/pharmacology*; beta-Galactosidase/analysis*; beta-Galactosidase/metabolism; Cell Cycle/drug effects*; Cell Cycle/genetics; Cells, Cultured; Chromans/pharmacology*; Diploidy; Fibroblasts/cytology; Fibroblasts/drug effects*; Fibroblasts/metabolism; Humans; RNA, Messenger/metabolism; Vitamin E/analogs & derivatives*; Vitamin E/pharmacology; Biomarkers/analysis; Interleukin-6/genetics; Interleukin-6/metabolism; Up-Regulation/drug effects; Retinoblastoma Protein/genetics; Retinoblastoma Protein/metabolism; Cell Aging/drug effects*; Cell Aging/genetics; Cyclin D1/genetics; Cyclin D1/metabolism; Matrix Metalloproteinase 1/genetics; Matrix Metalloproteinase 1/metabolism; Collagen Type I/genetics; Collagen Type I/metabolism
  9. Isa NM, Abdelwahab SI, Mohan S, Abdul AB, Sukari MA, Taha MM, et al.
    Braz. J. Med. Biol. Res., 2012 Jun;45(6):524-30.
    PMID: 22358425
    The current in vitro study was designed to investigate the anti-inflammatory, cytotoxic and antioxidant activities of boesenbergin A (BA), a chalcone derivative of known structure isolated from Boesenbergia rotunda. Human hepatocellular carcinoma (HepG2), colon adenocarcinoma (HT-29), non-small cell lung cancer (A549), prostate adenocarcinoma (PC3), and normal hepatic cells (WRL-68) were used to evaluate the cytotoxicity of BA using the MTT assay. The antioxidant activity of BA was assessed by the ORAC assay and compared to quercetin as a standard reference antioxidant. ORAC results are reported as the equivalent concentration of Trolox that produces the same level of antioxidant activity as the sample tested at 20 µg/mL. The toxic effect of BA on different cell types, reported as IC50, yielded 20.22 ± 3.15, 10.69 ± 2.64, 20.31 ± 1.34, 94.10 ± 1.19, and 9.324 ± 0.24 µg/mL for A549, PC3, HepG2, HT-29, and WRL-68, respectively. BA displayed considerable antioxidant activity, when the results of ORAC assay were reported as Trolox equivalents. BA (20 µg/mL) and quercetin (5 µg/mL) were equivalent to a Trolox concentration of 11.91 ± 0.23 and 160.32 ± 2.75 µM, respectively. Moreover, the anti-inflammatory activity of BA was significant at 12.5 to 50 µM and without any significant cytotoxicity for the murine macrophage cell line RAW 264.7 at 50 µM. The significant biological activities observed in this study indicated that BA may be one of the agents responsible for the reported biological activities of B. rotunda crude extract.
    MeSH terms: Analysis of Variance; Animals; Anti-Inflammatory Agents/pharmacology*; Anti-Inflammatory Agents/therapeutic use; Antineoplastic Agents, Phytogenic/pharmacology*; Antineoplastic Agents, Phytogenic/therapeutic use; Antioxidants/pharmacology*; Antioxidants/therapeutic use; Chalcone/isolation & purification; Chalcone/pharmacology*; Chromatography; Drug Screening Assays, Antitumor/methods; Humans; Phytotherapy/methods*; Neoplasms/drug therapy*; Rhizome; Zingiberaceae/chemistry*; Cell Line, Tumor; Mice; In Vitro Techniques
  10. Hussaini J, Mutusamy S, Omar R, Rajagopalan R, Narayanan P
    Acta Med Iran, 2012;50(2):151-2.
    PMID: 22359087
    We report a rare case of base of tongue tuberculosis following pulmonary tuberculosis. Patient presented to us with chief complaints of sore throat and pain on swallowing for period of 3 months. On examination with 70 degree telescope, we observed an ulcer on right side of base of tongue. The edges of the ulcer appeared to be undermined with whitish slough at the centre of the ulcer. Examination of neck showed a multiple small palpable middle deep cervical lymph nodes on right side of neck. Biopsy of the ulcer was taken, which showed granulomatous inflammation, suggestive of tuberculosis. Laboratory investigations revealed a raise in erythrocyte sedimentation rate, sputum for acid fast bacilli was strongly positive. Chest X ray was performed for patient showed multiple areas of consolidation. Patient was referred to chest clinic for further management of tuberculosis and was started on anti-tuberculous drugs. In conclusion tuberculosis of oral cavity is rare, but should be considered among one of the differential diagnosis of the oral lesions and biopsy is necessary to confirm the diagnosis.
    MeSH terms: Biopsy; Diagnosis, Differential; Humans; Male; Middle Aged; Tongue Diseases/diagnosis*; Tuberculosis, Oral/diagnosis*
  11. Jalil MA, Abdolkarim A, Saktioto T, Ong CT, Yupapin PP
    Int J Nanomedicine, 2012;7:773-9.
    PMID: 22359455 DOI: 10.2147/IJN.S27625
    In this study, we have generated terahertz (THz) frequency by a novel design of microring resonators for medical applications. The dense wavelength-division multiplexing can be generated and obtained by using a Gaussian pulse propagating within a modified PANDA ring resonator and an add/drop filter system. Our results show that the THz frequency region can be obtained between 40-50 THz. This area of frequency provides a reliable frequency band for THz pulsed imaging.
    MeSH terms: Histocytochemistry/instrumentation; Humans; Male; Models, Theoretical; Prostatic Neoplasms/chemistry; Terahertz Radiation; Terahertz Imaging/instrumentation*; Terahertz Imaging/methods*; Optics and Photonics/instrumentation*
  12. Nagashekhara M, Agil SO, Ramasamy R
    J Basic Clin Pharm, 2012 Mar;3(2):265-7.
    PMID: 24826035
    Study of marketing norm perception among medical representatives is an under-portrayed component that deserves further perusal in the pharmaceutical industry. The purpose of this study is to find out the perception of marketing norms among medical representatives. The research design is quantitative and cross sectional study with medical representatives as unit of analysis. Data is collected from medical representatives (n=300) using a simple random and cluster sampling using a structured questionnaire. Results indicate that there is no difference in the perception of marketing norms among male and female medical representatives. But there is a difference in opinion among domestic and multinational company's medical representatives. Educational back ground of medical representatives also shows the difference in opinion among medical representatives. Degree holders and multinational company medical representatives have high perception of marketing norms compare to their counterparts. The researchers strongly believe that mandatory training on marketing norms is beneficial in decision making process during the dilemmas in the sales field.
  13. Muslim D, Mohd E, Sallehudin A, Tengku Muzaffar T, Ezane A
    Malays Orthop J, 2012 Mar;6(1):35-9.
    PMID: 25279040 MyJurnal DOI: 10.5704/MOJ.1203.011
    The Osteoporosis Self-Assessment Tool for Asians (OSTA) score has been developed to identify women at risk of osteoporosis. It can be used as a screening tool for patients at risk who would benefit from bone mineral density measurement and treatment. It was developed based on data from eight countries including Malaysia. However, most subjects were of Chinese (59%). This study evaluated the performance of OSTA among 152 post-menopausal Malay women. OSTA score calculation and DEXA scan were performed. Our results showed that the OSTA score is a good predictor of patients at risk of osteoporosis based on BMD measurements at the proximal femur. Instrument sensitivity was 87.5%, specificity was 95.8%, positive predictive value (PPV) was 0.538, negative predictive value (NPV) was 0.993, and the area under the receiver operating characteristic curve (ROC) was 0.895. We conclude that use of the OSTA score in postmenopausal Malay women is effective and has adequate sensitivity and specificity.
    MeSH terms: Adult; Cross-Sectional Studies; Female; Malaysia; Malaysia/ethnology; Osteoporosis, Postmenopausal*
  14. Zulkarnaen M, Pan K, Shanmugam P, Ibrahim Z, Chan W
    Malays Orthop J, 2012 Mar;6(1):49-52.
    PMID: 25279044 MyJurnal DOI: 10.5704/MOJ.1203.003
    ABSTRACT: Synovial sarcoma is primarily a soft tissue malignancy that most often affects adolescents and young adults. It very rarely presents as a primary bone tumour and has only been reported in nine other cases to date. We report a case of primary synovial sarcoma arising from the proximal femur in a 57-year-old man.

    KEY WORDS: Synovial sarcoma, primary bone tumour.

  15. Pan K, Chan W, Ong G, Zulqarnaen M, Norlida D
    Malays Orthop J, 2012 Mar;6(1):57-60.
    PMID: 25279046 MyJurnal DOI: 10.5704/MOJ.1203.005
    This report details the case of a 12-year-old girl with a painful, progressive swelling of the medial portion of the clavicle with no history of trauma or other constitutional symptoms. All laboratory investigations were normal except for an elevated erythrocyte sedimentation rate (ESR). Initial plain radiographs showed a destructive lesion with magnetic resonance imaging showing features of malignancy. Biopsies revealed osteomyelitis, but with negative bacterial cultures and no evidence of malignancy. Treatment with antibiotics did not result in a favourable response. Over time, the swelling increased in size with episodic exacerbations of pain. Follow-up radiographs showed sclerosis and hyperostosis. After five years, this was recognized as non-bacterial chronic recurrent osteomyelitis of the clavicle.
    MeSH terms: Anti-Bacterial Agents; Biopsy; Blood Sedimentation; Child; Clavicle; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Neoplasms; Osteomyelitis; Pain; Radiography; Sclerosis; Hyperostosis
  16. Tan YN, Matthews KR, Di R, Ayob MK
    Probiotics Antimicrob Proteins, 2012 Mar;4(1):59-65.
    PMID: 26781737 DOI: 10.1007/s12602-012-9091-1
    Palm kernel expeller (PKE), the by-product derived from the palm kernel oil milling industry, is commonly added to ruminant feed as a source of protein. Recent research has demonstrated that the enzymatically hydrolyzed protein is inhibitory to spore-forming bacteria including Bacillus cereus. The trypsin-hydrolyzed PKE peptide appears to disrupt the membrane integrity and inhibit the intracellular macromolecule metabolism of B. cereus. The addition of the PKE peptide (350 and 700 μg/ml) to B. cereus cultures triggered the efflux of K(+) and caused the depletion of the intracellular ATP. However, no proportional increase in cell's extracellular ATP was observed. Analysis of the biosynthesis of macromolecules demonstrated that RNA was affected by the PKE peptide. Results of this study suggest that the PKE peptide is bacteriostatic interfering with membrane integrity and forming membrane pores permitting the efflux of K(+) and interferes with intracellular biopolymer synthesis.
  17. Yong HW, Zubaidah J, Saidi M, Zailina H
    Asian J Psychiatr, 2012 Mar;5(1):38-42.
    PMID: 26878945 DOI: 10.1016/j.ajp.2011.12.007
    Distress thermometer (DT) is a single-item measure generated to assess the psychological distress among cancer patients. The aim of this study was to validate the translated DT as a tool to determine the psychological distress level and assess the factors associated with distress among the working breast cancer survivors and also to compare with the Hospital Anxiety and Depression Scale (HADS).
  18. Dunn RA, Tan AK, Nayga RM
    Ethn Health, 2012;17(5):493-511.
    PMID: 22360320 DOI: 10.1080/13557858.2012.661407
    OBJECTIVE: Obesity prevalence is unequally distributed across gender and ethnic group in Malaysia. In this paper, we examine the role of socioeconomic inequality in explaining these disparities.
    DESIGN: The body mass index (BMI) distributions of Malays and Chinese, the two largest ethnic groups in Malaysia, are estimated through the use of quantile regression. The differences in the BMI distributions are then decomposed into two parts: attributable to differences in socioeconomic endowments and attributable to differences in responses to endowments.
    RESULTS: For both males and females, the BMI distribution of Malays is shifted toward the right of the distribution of Chinese, i.e., Malays exhibit higher obesity rates. In the lower 75% of the distribution, differences in socioeconomic endowments explain none of this difference. At the 90th percentile, differences in socioeconomic endowments account for no more than 30% of the difference in BMI between ethnic groups.
    CONCLUSIONS: Our results demonstrate that the higher levels of income and education that accrue with economic development will likely not eliminate obesity inequality. This leads us to conclude that reduction of obesity inequality, as well the overall level of obesity, requires increased efforts to alter the lifestyle behaviors of Malaysians.
    MeSH terms: Adolescent; Adult; Aged; Educational Status; Ethnic Groups/statistics & numerical data*; Female; Food Habits; Health Surveys; Humans; Income; Malaysia; Malaysia/epidemiology; Male; Middle Aged; Obesity/ethnology*; Regression Analysis; Sex Factors; Social Class*; Body Mass Index; Prevalence; Asian Continental Ancestry Group/ethnology; Health Status Disparities*; Young Adult
  19. Haron H, Yusof MR, Maskon O, Ooi J, Rahman MR
    Heart Surg Forum, 2012 Feb;15(1):E59-60.
    PMID: 22360910 DOI: 10.1532/HSF98.20111000
    Papillary fibroelastoma is a rare primary tumor of the heart valves. This lesion can occur on any of the valves or endothelial surface of the heart and has been detected by echocardiography, by cardiac catheterization, during open heart operations for other conditions, and at autopsy. Because of the potential for comorbidities, this tumor should be removed. We present the case of an elderly man with a diagnosis of severe mitral valve regurgitation and moderate tricuspid valve regurgitation who was suspected to have a tricuspid valve vegetation. Mitral valve replacement, tricuspid valve repair, and excision of the lesion were performed successfully. A histologic examination of the vegetation confirmed it to be a papillary fibroelastoma. We present this case to emphasize the rarity of this tumor and the importance of a correct diagnosis to avoid delaying its prompt and definitive management.
    MeSH terms: Aged; Antifungal Agents/therapeutic use; Diagnosis, Differential; Fibroma/diagnosis*; Fibroma/pathology; Fibroma/ultrasonography; Heart Neoplasms/diagnosis*; Heart Neoplasms/pathology; Heart Neoplasms/ultrasonography; Humans; Male; Mitral Valve Insufficiency/pathology; Mitral Valve Insufficiency/surgery; Mitral Valve Insufficiency/ultrasonography; Papillary Muscles/pathology; Papillary Muscles/surgery; Papillary Muscles/ultrasonography*; Rheumatic Heart Disease/diagnosis; Tricuspid Valve/pathology; Tricuspid Valve/surgery; Tricuspid Valve/ultrasonography*; Tricuspid Valve Insufficiency/pathology; Tricuspid Valve Insufficiency/surgery; Tricuspid Valve Insufficiency/ultrasonography; Heart Valve Prosthesis Implantation
  20. Lai PS, Chua SS, Tan CH, Chan SP
    BMC Med Res Methodol, 2012 Feb 24;12:18.
    PMID: 22361093 DOI: 10.1186/1471-2288-12-18
    BACKGROUND: Patient's knowledge on diabetes, hypertension and hyperlipidaemia and its medications can be used as one of the outcome measures to assess the effectiveness of educational intervention. To date, no such instrument has been validated in Malaysia. Therefore, the aim of this study was to evaluate the validity and reliability of the Diabetes, Hypertension and Hyperlipidemia (DHL) knowledge instrument for assessing the knowledge of patients with type 2 diabetes in Malaysia.

    METHODS: A 28-item instrument which comprised of 5 domains: diabetes, hypertension, hyperlipidemia, medications and general issues was designed and tested. One point was given for every correct answer, whilst zero was given for incorrect answers. Scores ranged from 0 to 28, which were then converted into percentage. This was administered to 77 patients with type 2 diabetes in a tertiary hospital, who were on medication(s) for diabetes and who could understand English (patient group), and to 40 pharmacists (professional group). The DHL knowledge instrument was administered again to the patient group after one month. Excluded were patients less than 18 years old.

    RESULTS: Flesch reading ease was 60, which is satisfactory, while the mean difficulty factor(SD) was 0.74(0.21), indicating that DHL knowledge instrument was moderately easy. Internal consistency of the instrument was good, with Cronbach's α = 0.791. The test-retest scores showed no significant difference for 26 out of the 28 items, indicating that the questionnaire has achieved stable reliability. The overall mean(SD) knowledge scores was significantly different between the patient and professional groups [74.35(14.88) versus 93.84(6.47), p < 0.001]. This means that the DHL knowledge instrument could differentiate the knowledge levels of participants. The DHL knowledge instrument shows similar psychometric properties as other validated questionnaires.

    CONCLUSIONS: The DHL knowledge instrument shows good promise to be adopted as an instrument for assessing diabetic patients' knowledge concerning their disease conditions and medications in Malaysia.

    MeSH terms: Adult; Diabetes Mellitus, Type 2*; Educational Measurement/standards*; Educational Measurement/statistics & numerical data; Humans; Hyperlipidemias*; Hypertension*; Health Knowledge, Attitudes, Practice*; Malaysia; Patient Education as Topic; Patients/psychology; Pharmacists/psychology; Professional Competence; Psychometrics/instrumentation*; Surveys and Questionnaires; Reproducibility of Results; Outcome Assessment (Health Care)
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