Molecular imaging employing (18)[F]FDG-PET/CT enables in-vivo visualization, characterisation and measurement of biological process in tumour at the molecular and cellular level. In oncology, this approach can be directly applied as translational biomarkers of disease progression. In this article, the improved roles of FDG as an in-vivo glycolytic marker which reflect biological changes across in-vitro cellular environment are discussed. New understanding in how altered metabolism via glycolytic downstream drivers of malignant transformation as reviewed below offers unique promise as to monitor tumour aggressiveness and hence optimize the therapeutic management.
MeSH terms: Glycolysis; Humans; Mutation; Neoplasm Recurrence, Local/diagnosis; Neoplasms/diagnosis*; Neoplasms/genetics; Predictive Value of Tests; Sensitivity and Specificity; Biomarkers, Tumor/analysis*; Survival Analysis; Cell Dedifferentiation; Early Detection of Cancer; Multimodal Imaging*
OBJECTIVES: To assess the practices associated with the application of therapeutic drug monitoring (TDM) for antiepileptic drugs (AEDs) in the management of children with structural-metabolic epilepsy.
METHODS: It was a retrospective chart review and included children aged ≥2 years old with structural-metabolic epilepsy, treated with AEDs, and received TDM. The data were extracted from the medical records.
RESULTS: Thirty-two patients were identified with 50 TDM assays. In two thirds of the assays, "check level" and "recheck level" were the reasons behind the requesting of serum level monitoring of AEDs. Knowledge of serum AED levels led to alterations in the management in 60% of the assays. Thirty-two (76%) pediatrician's actions were consistent with the recommendation of TDM pharmacist. Forty-nine (98%) levels were appropriately indicated. In relation to the appropriateness of sampling time, 9 (18%) levels were not assessed due to missing data. Twenty-seven (54%) levels were appropriately sampled.
CONCLUSIONS: More studies should be designed to improve the component of the current TDM request form, especially in the reason section. By the same token, the number of pointless assays and the costs to the health care system can be reduced both by enhancing and improving the educational standards of the requesting neurologists.
KEYWORDS: Malaysia; epilepsy; neurology; pediatrics; therapeutic drug monitoring
Study site: Paediatric Neurology Clinic, Hospital Pulau Pinang, Malaysia
The aim of this study was to evaluate the impact of a written asthma action plan (WAAP) on reducing unscheduled doctor visits, asthma control and quality of life in children with all severities of asthma. This was a randomised controlled, single-blinded study whereby 80 children with asthma were randomly assigned to be either provided a WAAP or verbally counseled . The number of asthmatic exacerbations requiring unscheduled doctor visits, asthma control and quality of life were monitored over 9 mo. At the end of the study, there was no significant difference in the number of unscheduled doctor visits between the 2 groups (p = 0.352). There was no significant difference in asthma control or quality of life between both groups. Hence, the WAAP did not reduce unscheduled doctor visits, nor improve asthma control or quality of life in children with all severities of asthma.
The aim of this study was to evaluate the effect of electroporation (2.5-7.5 kV cm⁻¹ for 3.0-4.0 ms) on the growth of lactobacilli and bifidobacteria, membrane properties and bioconversion of isoflavones in mannitol-soymilk.
This study was conducted to investigate the effectiveness of dose-saving protocols in dual-source computed tomography (CT) coronary angiography compared with invasive coronary angiography (ICA). On 50 patients who underwent coronary CT angiography was performed dual-source CT (DSCT) and compared with ICA procedures. Entrance skin dose (ESD), which was measured at the thyroid gland, and effective dose (E) were assessed for both imaging modalities. The mean ESD measured at the thyroid gland was the highest at 120 kVp, followed by the 100 kVp DSCT and the ICA protocols with 4.0±1.8, 2.7±1.0 and 1.1±1.2 mGy, respectively. The mean E was estimated to be 10.3±2.1, 6.2±2.3 and 5.3±3.4 mSv corresponding to the 120-kVp, 100-kVp DSCT and ICA protocols, respectively. The application of 100 kVp in DSCT coronary angiography is feasible only in patients with a low body mass index of <25 kg m(-2), which leads to a significant dose reduction with the radiation dose being equivalent to that of ICA.
Keratinocyte traction forces play a crucial role in wound healing. The aim of this study was to develop a novel cell traction force (CTF) transducer system based on cholesteryl ester liquid crystals (LC). Keratinocytes cultured on LC induced linear and isolated deformation lines in the LC surface. As suggested by the fluorescence staining, the deformation lines appeared to correlate with the forces generated by the contraction of circumferential actin filaments which were transmitted to the LC surface via the focal adhesions. Due to the linear viscoelastic behavior of the LC, Hooke's equation was used to quantify the CTFs by associating Young's modulus of LC to the cell induced stresses and biaxial strain in forming the LC deformation. Young's modulus of the LC was profiled by using spherical indentation and determined at approximately 87.1±17.2kPa. A new technique involving cytochalasin-B treatment was used to disrupt the intracellular force generating actin fibers, and consequently the biaxial strain in the LC induced by the cells was determined. Due to the improved sensitivity and spatial resolution (∼1μm) of the LC based CTF transducer, a wide range of CTFs was determined (10-120nN). These were found to be linearly proportional to the length of the deformations. The linear relationship of CTF-deformations was then applied in a bespoke CTF mapping software to estimate CTFs and to map CTF fields. The generated CTF map highlighted distinct distributions and different magnitude of CTFs were revealed for polarized and non-polarized keratinocytes.
Characterization of starch properties and functionality can apply breeding program selection for desirable traits such as eating, cooking and processing qualities to meet consumer preference. Low amylose content is generally preferred in Malaysia because of cohesive, tender and glossy cooked rice. Rice high in short-chain amylopectin has a lower transition temperature of starch gelatinization. In the continuing search for improved starch quality in rice cultivars a study was carried out with new mutant lines MR219-4 and MR219-9, derived from MR219.
The first objective of this study was to provide data of arsenic (As) levels in Peninsular Malaysia based on soil samples and accumulation of As in Centella asiatica collected from 12 sampling sites in Peninsular Malaysia. The second objective was to assess the accumulation of As in transplanted C. asiatica between control and semi-polluted or polluted sites. Four sites were selected which were UPM (clean site), Balakong (semi-polluted site), Seri Kembangan (semi-polluted site) and Juru (polluted site). The As concentrations of plant and soil samples were determined by Instrumental Neutron Activation Analysis. The As levels ranged from 9.38 to 57.05 μg/g dw in soils, 0.21 to 4.33 μg/g dw in leaves, 0.18 to 1.83 μg/g dw in stems and 1.32-20.76 μg/g dw in roots. All sampling sites had As levels exceeding the CCME guideline (12 μg/g dw) except for Kelantan, P. Pauh, and Senawang with P. Klang having the highest As in soil (57.05 μg/g dw). In C. asiatica, As accumulation was highest in roots followed by leaves and stems. When the As level in soils were higher, the uptake of As in plants would also be increased. After the transplantation of plants to semi-polluted and polluted sites for 3 weeks, all concentration factors were greater than 50 % of the initial As level. The elimination factor was around 39 % when the plants were transplanted back to the clean sites for 3 weeks. The findings of the present study indicated that the leaves, stems and roots of C. asiatica are ideal biomonitors of As contamination. The present data results the most comprehensive data obtained on As levels in Malaysia.
This is a retrospective study of the outbreaks of foot-and-mouth disease (FMD) in Peninsular Malaysia between 2001 and May 2007. In total, 270 outbreaks of FMD were recorded. Serotype O virus (89.95 %) and serotype A (7.7 %) had caused the outbreaks. Significant differences on the occurrence of FMD were found between the years (t = 5.73, P = 0.000, df = 11), months (t = 4.7, P = 0.000, df = 11), monsoon season (t = 2.63, P = 0.025, df = 10) and states (t = 4.84, P = 0.001, df = 10). A peak of outbreaks observed in 2003 could be due to increased animal movement and the other peak in 2006 could be due to a compromised FMD control activities due to activities on the eradication of highly pathogenic avian influenza. Cattle (86 % of outbreaks) suffered the most. However, no difference in disease occurrence between species was observed. The populations of cattle (r = 0.672, P = 0.023) and sheep (r = 0.678, P = 0.022) were significantly correlated with occurrence of FMD. Movement of animals (66 % of outbreaks) was the main source for outbreaks. A combination of control measures were implemented during outbreaks. In conclusion, the findings of this study show that FMD is endemic in Peninsular Malaysia, and information gained could be used to improve the existing control strategy.
Using genome-wide case-control association approach, the current study aimed to determine whether genetic polymorphism(s) is/are associated with H. pylori infection among ethnic Malays from the north-eastern region of Peninsular Malaysia, a region with an exceptionally low prevalence for H. pylori infection and gastric cancer.
MeSH terms: Adult; Aged; Aged, 80 and over; Humans; Malaysia/ethnology; Middle Aged; Genes, DCC*; Helicobacter pylori*; Helicobacter Infections/genetics*; Genetic Predisposition to Disease; Polymorphism, Single Nucleotide*
This study examined the kinematic differences between a body-powered prosthesis and a biomechatronics prosthesis as a transradial amputee performed activities that involve flexion/extension and supination/pronation of the wrist.
The counterfeit drug trade has become widespread and has developed into a substantial threat to both the public's health and the pharmaceutical industry.
MeSH terms: Administrative Personnel*; Health Policy; Humans; Health Knowledge, Attitudes, Practice*; Perception; Pharmacies; Pharmacists*; Sudan; Counterfeit Drugs*
BACKGROUND: Treatment default among the smokers hinders the effectiveness of the delivery of cessation services. While many studies have predicted the defaulters' characteristics, the reasons why these smokers dropped out and continued smoking are seldom explored.
OBJECTIVES: This study examined the barriers encountered by such smokers and their respective health care providers (HCPs) in relation to the discontinuation of cessation treatment.
METHODS: From May 2010 to March 2011, 15 current adult smokers and 9 HCPs from 2 Quit Smoking Clinics (QSCs) in the Melaka Tengah District, Malacca, Malaysia were interviewed on smoking, cessation, and the QSC. Interviews were audio recorded and transcribed verbatim. The transcripts were subsequently translated into English and analyzed using thematic analysis.
RESULTS: The barriers encountered were categorized as Individual- and Clinic-level. Both smokers and HCPs acknowledged that the smokers' low intrinsic motivation was the individual-level barrier. The clinic-level barriers were the mismatched perceptions of smokers and HCPs regarding the HCPs' roles, skills, and attitudes, as well as the availability and efficacy of smoking cessation aids (SCAs). While the smokers viewed the program as not helpful, the HCPs cited the lack of organizational support as their main barrier.
CONCLUSIONS: The reasons for treatment default centered on the overall dissatisfaction with the treatment (due to the program, HCP, and SCA factors) combined with the smokers' low intrinsic motivation. Optimizing the interplay of the extrinsic motivational cues, such as the HCP and SCA factors, would complement the smoker's low intrinsic motivation and thus encourage treatment retention. However, it is necessary to strike a balance between the individual smoker's needs and the availability of organizational support.
KEYWORDS: Qualitative; Smoking cessation; Treatment discontinuation
Study site: Quite smoking clinics, Klinik Kesihatan Ayer Keroh, Hospital Melaka, Melaka, Malaysia
MeSH terms: Adult; Aged; Ambulatory Care Facilities; Attitude of Health Personnel; Female; Health Personnel; Hospitals, General; Humans; Malaysia; Male; Middle Aged; Motivation; Organizational Objectives; Patient Compliance*; Smoking Cessation*; Patient Satisfaction; Outcome Assessment (Health Care); Qualitative Research; Young Adult
Ever since the 9/11 terrorist attack, many countries are considering the use of smart national identity card (SNIC) which has the ability to identify terrorists due to its biometric verification function. However, there are many ergonomics issues in the use of SNIC, e.g. card credibility. This research presents a case study survey of Malaysian users. Although most citizens (>96%) own MyKad (Malaysia SNIC), many do not carry it around and use its applications. This defeats one of its main purposes, i.e. combating terrorism. Thus, the research investigates ergonomics issues affecting the citizens' Intention to Use (ITU) MyKad for homeland security by using an extended technology acceptance model. Five hundred questionnaires were collected and analysed using structural equation modelling. Results show that perceived credibility and performance expectancy are the key issues. The findings provide many countries with insights into methods of addressing ergonomics issues and increasing adoption of SNIC for homeland security.
MeSH terms: Adolescent; Adult; Anxiety/psychology; Attitude; Female; Humans; Malaysia; Male; Middle Aged; Social Control Policies*; Public Opinion; Security Measures*; Social Desirability; Social Facilitation; Technology; Databases, Factual; Terrorism/prevention & control; Intention; Trust; Law Enforcement; Young Adult; Biometric Identification/instrumentation*
The purpose of this study was to improve the survival of Bifidobacterium animalis subsp. lactis 10140 during freeze-drying process by microencapsulation, using a special pediatric prebiotics mixture (galactooligosaccharides and fructooligosaccharides). Probiotic microorganisms were encapsulated with a coat combination of prebiotics-calcium-alginate prior to freeze-drying. Both encapsulated and free cells were then freeze-dried in their optimized combinations of skim milk and prebiotics. Response surface methodology (RSM) was used to produce a coating combination as well as drying medium with the highest cell viability during freeze-drying. The optimum encapsulation composition was found to be 2.1 % Na-alginate, 2.9 % prebiotic, and 21.7 % glycerol. Maximum survival predicted by the model was 81.2 %. No significant (p > 0.05) difference between the predicted and experimental values verified the adequacy of final reduced models. The protection ability of encapsulation was then examined over 120 days of storage at 4 and 25 °C and exposure to a sequential model of infantile GIT conditions including both gastric conditions (pH 3.0 and 4.0, 90 min, 37 °C) and intestinal conditions (pH 7.5, 5 h, 37 °C). Significantly improved cell viability showed that microencapsulation of B. lactis 10140 with the prebiotics was successful in producing a stable symbiotic powdery nutraceutical.
MeSH terms: Bifidobacterium/physiology*; Bifidobacterium/radiation effects; Drug Compounding; Drug Storage/methods; Freeze Drying*; Humans; Infant; Temperature; Time Factors; Colony Count, Microbial; Probiotics/radiation effects*; Infant Formula; Gastrointestinal Tract/microbiology*; Microbial Viability/radiation effects*
(i) To examine the incidence of new onset treated diabetes in patients treated with different types of statins and (ii) the relationship between the duration and dose of statins and the subsequent development of new onset treated diabetes.
RATIONALE: Despite the availability of various prevention guidelines on acute coronary syndrome (ACS), secondary prevention practice utilizing aspirin, beta-blockers, angiotensin converting enzyme inhibitors and statins still can be sub-optimal.
AIMS AND OBJECTIVES: To review and document the utilization of pharmacotherapy for the secondary prevention of ACS in patients discharged from a Malaysian hospital.
METHODS: A retrospective cross-sectional study was conducted at a tertiary hospital in Penang, Malaysia. Patients with a primary diagnosis of ACS were identified from medical records over a 4-month period. A range of clinical data was extracted from medical records, including medical history, clinical presentation and pharmacotherapy both on admission and at discharge. This audit focused on the use of four guideline-recommended therapies: aspirin ± clopidogrel, beta-blockers, statins and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARBs).
RESULTS: Data pertaining to a total of 380 ACS patients was extracted and reviewed, the mean age of the study population was 57.49 years and 73.9% of population was males. Patients with unstable angina accounted for 56.6% of the admissions whereas 23.4% and 20% of the patients were admitted for ST-elevation myocardial infarction and non-ST-segment elevation infarct respectively. 95.7% of the patients received antiplatelets comprising of at least aspirin, and 82% received aspirin plus clopidogrel. Furthermore, 80.3% of the patients received a beta-blocker at discharge, 95% a statin and 69.7% received either an ACEI or ARB. Compared with patients who presented with myocardial infarction (with or without ST-segment elevation), those presenting with unstable angina were less likely to receive the combination of aspirin plus clopidogrel or an ACEI/ARB at discharge. Patients over 65 years of age were also less likely to receive a beta-blocker at discharge, compared with younger patients.
CONCLUSIONS: There is a good adherence to evidence-based guidelines for the secondary prevention of ACS in this local setting. However, there is some potential underutilization in the older population and patients presenting with unstable angina.
KEYWORDS: acute coronary syndromes; evidence-based pharmacotherapy; secondary prevention; utilization
MeSH terms: Adult; Aged; Aged, 80 and over; Cardiovascular Agents/administration & dosage*; Cross-Sectional Studies; Drug Utilization/statistics & numerical data; Female; Humans; Malaysia; Male; Middle Aged; Retrospective Studies; Practice Guidelines as Topic*; Guideline Adherence/statistics & numerical data*; Acute Coronary Syndrome/prevention & control*; Evidence-Based Practice; Secondary Prevention/statistics & numerical data*; Tertiary Care Centers/statistics & numerical data
This work presents a study of human hair as a bio-indicator for detection of heavy metals as part of environmental health surveillance programs project to develop a subject of interest in the biomedical and environmental sciences. A total of 34 hair samples were analyzed that consisting of 29 samples from sanitation workers and five samples from students. The hair samples were prepared and treated in accordance to the International Atomic Energy Agency (IAEA) recommendations. The concentrations of heavy metals were analyzed using the energy dispersive X-ray fluorescence (EDXRF) technique by X-50 Mobile X-ray Fluorescence (XRF) at Oceanography Institute, Universiti Malaysia Terengganu. The performance of EDXRF analyzer was tested by Standard Reference Material (SRM 2711) Montana Soil which was in good agreement with certified value within 14% deviations except for Hg. While seven heavy metals: Mn, Fe, Ni, Cu, Zn, Se, and Sb were detected in both groups, three additional elements, i.e. As, Hg and Pb, were detected only in sanitation workers group. For sanitation workers group, the mean concentration of six elements, Mn, Fe, Cu, Zn, Se, and Sb, shows elevated concentration as compared to the control samples concentration. Results from both groups were compared and discussed in relation to their respective heavy metals concentrations.
OBJECTIVES: The prognostic significance of rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (anti-CCP) in rheumatoid arthritis (RA) remains contentious due to the conflicting lines of evidence. This study aims to determine the association between RF isotypes and anti-CCP with disease severity in RA patients from three ethnic groups.
METHODS: A total of 147 RA patients from three different ethnic groups (Malays, Chinese, and Indians) who fulfilled the 1987 American College of Rheumatology (ACR) revised criteria for RA were recruited into this study. The seroprevalence of RF isotypes immunoglobulin (Ig)A, IgG, and IgM, as well as anti-CCP was determined using commercial enzyme-linked immunosorbent assay (ELISA) kits. Multinomial regression analysis was performed to assess the independent effects of autoantibody status on the development of deforming and erosive RA and the presence of extra-articular manifestations (EAM).
RESULTS: In Chinese patients, we found a significant association (p < 0.05) between IgG RF and anti-CCP and the presence of erosive disease, as well as IgM RF and IgG RF with the presence of joint deformities. In Indian patients, IgM RF was associated with deforming disease, whereas none of the antibodies were associated with disease severity in Malay patients. Multinomial regression analysis revealed that IgG RF was the most important predictor variable for erosive disease in Chinese patients, and IgM RF the only predictor variable associated with deforming disease in both Chinese and Indian RA patients.
CONCLUSIONS: There is variability in the phenotypic association of RF isotypes and anti-CCP in relation to disease severity of RA in the three ethnic groups. RF, in particular, IgG and IgM, may be better prognosticators of severe disease in Chinese and Indian patients.
To assess the validity and reproducibility of a new computer-based physical activity questionnaire (cPAQ) to estimate the habitual physical activity levels in Malaysian adolescents.
MeSH terms: Adolescent; Child; Cross-Sectional Studies; Female; Heart Rate; Humans; Malaysia; Male; Pilot Projects; Surveys and Questionnaires*; Exercise*; Monitoring, Ambulatory