Browse publications by year: 2013

  1. Oshkour AA, Abu Osman NA, Yau YH, Tarlochan F, Abas WA
    Proc Inst Mech Eng H, 2013 Jan;227(1):3-17.
    PMID: 23516951
    This study aimed to develop a three-dimensional finite element model of a functionally graded femoral prosthesis. The model consisted of a femoral prosthesis created from functionally graded materials (FGMs), cement, and femur. The hip prosthesis was composed of FGMs made of titanium alloy, chrome-cobalt, and hydroxyapatite at volume fraction gradient exponents of 0, 1, and 5, respectively. The stress was measured on the femoral prosthesis, cement, and femur. Stress on the neck of the femoral prosthesis was not sensitive to the properties of the constituent material. However, stress on the stem and cement decreased proportionally as the volume fraction gradient exponent of the FGM increased. Meanwhile, stress became uniform on the cement mantle layer. In addition, stress on the femur in the proximal part increased and a high surface area of the femoral part was involved in absorbing the stress. As such, the stress-shielding area decreased. The results obtained in this study are significant in the design and longevity of new prosthetic devices because FGMs offer the potential to achieve stress distribution that more closely resembles that of the natural bone in the femur.
    MeSH terms: Biocompatible Materials/chemistry*; Computer Simulation; Femur/physiology*; Femur/surgery*; Hip Prosthesis*; Humans; Models, Biological*; Prosthesis Design; Tensile Strength; Weight-Bearing/physiology*; Computer-Aided Design; Equipment Failure Analysis; Finite Element Analysis; Elastic Modulus/physiology
  2. Chan WK, Tan AT, Vethakkan SR, Tah PC, Vijayananthan A, Goh KL
    J Gastroenterol Hepatol, 2013 Aug;28(8):1375-83.
    PMID: 23517307 DOI: 10.1111/jgh.12204
    BACKGROUND AND AIM:
    There is currently no published study comparing prevalence of non-alcoholic fatty liver disease (NAFLD) and associated factors among diabetics of different ethnicity in the Asia-Pacific region.

    METHODS:
    Cross-sectional study of consecutive patients in the Diabetic Clinic in University of Malaya Medical Centre. The Global Physical Activity Questionnaire and a semiquantitative food-frequency questionnaire were used to assess physical activity and dietary intake, respectively. Diagnosis of NAFLD was ultrasound-based and following exclusion of significant alcohol intake.

    RESULTS:
    Data for 399 patients were analyzed (mean age 62.3 ± 10.5 years, 43.1% men). The racial distribution was Chinese 43.6%, Indian 33.1%, Malay 22.3%, and others 1.0%. The prevalence of NAFLD was 49.6%. On univariate analysis, factors associated with NAFLD were age < 65 years, race, obesity, central obesity, glycated hemoglobin ≥ 7.0%, and elevated serum alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels. Patients with low physical activity were more likely to have NAFLD (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.06-2.63, P = 0.020). The prevalence of NAFLD was highest among Malays (60.7%), followed by Indians (51.5%), and lowest among Chinese (42.0%) consistent with higher prevalence of central obesity and higher percentage calorie intake from fat in the former groups of patients. On multivariate analysis, independent factors associated with NAFLD were central obesity (OR = 2.20, 95% CI = 1.29-3.75, P = 0.004) and elevated serum ALT level (OR = 1.98, 95% CI = 1.21-3.25, P = 0.007).

    CONCLUSIONS:
    NAFLD was seen in half of a cohort of diabetic patients and was independently associated with central obesity and elevated serum ALT level. Prevalence of NAFLD was different and paralleled the difference in prevalence of central obesity and in percentage calorie intake from fat among the different ethnic groups.

    © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

    KEYWORDS:
    diabetes mellitus; dietary intake; epidemiology; ethnicity; non-alcoholic fatty liver disease; physical activity
    Study site: Diabetic clinic, University Malaya Medical Centre (UMMC)
    MeSH terms: Aged; Alanine Transaminase/blood; Energy Intake; China/ethnology; Cross-Sectional Studies; Dietary Fats; Fatty Liver/diagnosis; Fatty Liver/ethnology*; Fatty Liver/etiology; Fatty Liver/epidemiology*; Female; Forecasting; Hospitals, University; Hospitals, University/statistics & numerical data*; Humans; India/ethnology; Malaysia/ethnology; Malaysia/epidemiology; Male; Middle Aged; Obesity/ethnology; Obesity/epidemiology; Cohort Studies; Prevalence; Diabetes Complications*; Non-alcoholic Fatty Liver Disease
  3. Bhore SJ, Amelia K, Wang E, Priyadharsini S, Shah FH
    Bioinformation, 2013;9(4):197-206.
    PMID: 23519320 DOI: 10.6026/97320630009197
    The identification of genes and understanding of genes' expression and regulation in common bean (Phaseolus vulgaris L.) is necessary in order to strategize its improvement using genetic engineering techniques. Generation of expressed sequence tags (ESTs) is useful in rapid isolation, identification and characterization of the genes. To study the gene expression in P. vulgaris pods tissue, ESTs generation work was initiated. Early stage and late stage bean-pod-tissues cDNA libraries were constructed using CloneMiner cDNA library construction kit. In total, 5972 EST clones were isolated using random method of gene isolation. While processing ESTs, we found lycopene β-cyclase (PvLCY-β) and β-carotene hydroxylase (PvCHY-β) gene's cDNA. In carotenoid biosynthesis pathway, PvLCY-β catalyzes the production of carotene; and PvCHY-β is known to function as a catalyst in the production of lutein and zeaxanthin. To understand more about PvLCY-β and PvCHY-β, both strands of both cDNA clones were sequenced using M13 forward and reverse primers. Nucleotide and deduced protein sequences were analyzed and annotated using online bioinformatics tools. Results showed that PvLCY-β and PvCHY-β cDNAs are 1639 and 1107 bp in length, respectively. Analysis results showed that PvLCY-β and PvCHY-β gene's cDNA contains an open reading frame (ORF) that encodes for 502 and 305 amino acid residues, respectively. The deduced protein sequence analysis results also showed the presence of conserved domains needed for PvLCY-β and PvCHY-β functions. The phylogenetic analysis of both PvLCY-β and PvCHY-β proteins showed it's closeness with the LCY-β and CHY-β proteins from Glycine max, respectively. The nucleotide sequence of PvLCY-β and PvCHY-β gene's cDNA and it's annotation is reported in this paper.
  4. Tan LY, Yin WF, Chan KG
    Sensors (Basel), 2013;13(3):3975-85.
    PMID: 23519352 DOI: 10.3390/s130303975
    Various parts of Piper nigrum, Piper betle and Gnetum gnemon are used as food sources by Malaysians. The purpose of this study is to examine the anti-quorum sensing (anti-QS) properties of P. nigrum, P. betle and G. gnemon extracts. The hexane, chloroform and methanol extracts of these plants were assessed in bioassays involving Pseudomonas aeruginosa PA01, Escherichia coli [pSB401], E. coli [pSB1075] and Chromobacterium violaceum CV026. It was found that the extracts of these three plants have anti-QS ability. Interestingly, the hexane, chloroform and methanol extracts from P. betle showed the most potent anti-QS activity as judged by the bioassays. Since there is a variety of plants that serve as food sources in Malaysia that have yet to be tested for anti-QS activity, future work should focus on identification of these plants and isolation of the anti-QS compounds.
    MeSH terms: Chromobacterium/drug effects; Escherichia coli/drug effects; Malaysia; Pseudomonas aeruginosa/drug effects; Piper nigrum/chemistry; Piper betle/chemistry; Gnetum/chemistry; Quorum Sensing/drug effects*
  5. Loh SY, Packer T, Chinna K, Quek KF
    J Cancer Surviv, 2013 Sep;7(3):331-42.
    PMID: 23519654 DOI: 10.1007/s11764-013-0274-x
    PURPOSE: Patient self-management enables living with a chronic disease effectively. This study examines the effectiveness of a 4-week self-management programme to enable self-management of the numerous after-effects and with breast cancer as a chronic disease.
    METHODS: Upon ethical approval, 147 multiethnic survivors (stages I-III breast cancer) received either a 4-week self-management intervention (n = 68) or usual care (n = 78) on a controlled clinical trial in a medical centre. The facilitator-led group intervention provides self-management support and skills for managing the medical, emotional and role tasks. Survivors completed the pre- and post-intervention measures on quality of life, distress and participation inventory.
    RESULTS: Multiple analyses of covariance (adjusted for baseline measures) showed significant differences between groups [F(6, 129) = 2.26, p = 0.04 at post-test and F(6, 129) = 4.090, p 
    MeSH terms: Adult; Aged; Breast Neoplasms/complications; Breast Neoplasms/epidemiology; Breast Neoplasms/therapy*; Chronic Disease; Continuity of Patient Care*; Depression/etiology; Depression/epidemiology; Female; Hospitals, University; Humans; Health Knowledge, Attitudes, Practice; Middle Aged; Patient Participation; Quality of Life; Self Care/methods*; Social Support; Program Evaluation; Treatment Outcome; Community Networks; Young Adult
  6. Chee KL, Ayob MK
    Food Sci Technol Int, 2013 Apr;19(2):109-22.
    PMID: 23520324 DOI: 10.1177/1082013212442185
    Response surface methodology was applied to study the optimization of palm kernel cake protein (PKCP) hexametaphosphate-assisted extraction. The optimum PKCP yield (28.37%) when extracted using 1.50% sodium hexametaphosphate (SHMP) of pH 10, at 50 °C, and the 1:70 (w/v) ratio of cake-to-solvent was significantly (P 
    MeSH terms: Amino Acids, Essential; Arginine/analysis; Calorimetry, Differential Scanning; Child, Preschool; Dietary Proteins/analysis*; Drug Stability; Humans; Hydrogen-Ion Concentration; Industrial Waste/analysis; Nutritive Value; Phosphates*; Plant Oils/chemistry*; Plant Proteins/isolation & purification*; Plant Proteins/chemistry*; Protein Denaturation; Solvents; Temperature; Glutamic Acid/analysis; Emulsifying Agents/chemistry; Hydrophobic and Hydrophilic Interactions
  7. Nurul-Fadhilah A, Teo PS, Huybrechts I, Foo LH
    PLoS One, 2013;8(3):e59297.
    PMID: 23520556 DOI: 10.1371/journal.pone.0059297
    Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents. However, the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined. Thus, the aim of the present study was to assess any associations between breakfast consumption practices and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years. A self-administered questionnaire on dietary behaviour and lifestyle practices and a dietary food frequency questionnaire were used. Body composition and adiposity indices were determined using standard anthropometric measurement protocols and dual energy χ-ray absorptiometry (DXA). Mean age of the participants was 15.3±1.9 years. The majority of participants (71.2%) fell in the normal body mass index (BMI) ranges. Breakfast consumption patterns showed that only half of the participants (50%) were consuming breakfast daily. Gender-specific multivariate analyses (ANCOVA) showed that in both boys and girls, those eating breakfast at least 5 times a week had significantly lower body weight, body mass index (BMI), BMI z-scores, waist circumference, body fat mass and percent body fat (%BF) compared to infrequent breakfast eaters, after adjustment for age, household income, pubertal status, eating-out and snacking practices, daily energy intakes, and daily physical activity levels. The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity. Therefore, daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth.
    MeSH terms: Adolescent; Adult; Age Factors; Energy Intake*; Child; Feeding Behavior/psychology*; Female; Humans; Life Style*; Male; Socioeconomic Factors; Body Mass Index; Adiposity*
  8. Mazid MS, Rafii MY, Hanafi MM, Rahim HA, Latif MA
    Physiol Plant, 2013 Nov;149(3):432-47.
    PMID: 23521023 DOI: 10.1111/ppl.12054
    A field experiment was carried out in order to evaluate genetic diversity of 41 rice genotypes using physiological traits and molecular markers. All the genotypes unveiled variations for crop growth rate (CGR), relative growth rate (RGR), net assimilation rate (NAR), yield per hill (Yhill(-1)), total dry matter (TDM), harvest index (HI), photosynthetic rate (PR), leaf area index (LAI), chlorophyll-a and chlorophyll-b at maximum tillering stage. The CGR values varied from 0.23 to 0.76 gm cm(-2) day(-1). The Yhill(-1) ranged from 15.91 to 92.26 g, while TDM value was in the range of 7.49 to 20.45 g hill(-1). PR was found to vary from 9.40 to 22.34 µmol m(-2) s(-1). PR expressed positive relation with Yhill(-1). Significant positive relation was found between CGR and TDM (r = 0.61**), NAR and CGR (r = 0.62**) and between TDM and NAR (r = 0.31**). High heritability was found in RGR and Yhill(-1). Cluster analysis based on the traits grouped 41 rice genotypes into seven clusters. A total of 310 polymorphic loci were detected across the 20 inter-simple sequence repeats (ISSR) markers. The UPGMA dendrogram grouped 41 rice genotypes into 11 clusters including several sub-clusters. The Mantel test revealed positive correlation between quantitative traits and molecular markers (r = 0.41). On the basis of quantitative traits and molecular marker analyses parental genotypes, IRBB54 with MR84, IRBB60 with MR84, Purbachi with MR263, IRBB65 with BR29, IRBB65 with Pulut Siding and MRQ74 with Purbachi could be hybridized for future breeding program.
    MeSH terms: Genotype*; Plant Diseases; Oryza/genetics*; Oryza/growth & development; Oryza/immunology; Genetic Variation*; Cluster Analysis; Biomass*; Microsatellite Repeats; Random Amplified Polymorphic DNA Technique; Quantitative Trait, Heritable; Principal Component Analysis; Plant Development*
  9. Bay R, Ismail SB, Zahiruddin WM, Arifin WN
    BMC Urol, 2013;13:16.
    PMID: 23522405 DOI: 10.1186/1471-2490-13-16
    During the last few decades, marital tensions and stresses have influenced various dimensions of life. The objective of the current study was to examine the effects of combined psycho-physiological therapy (stretching therapy combined with breathing exercise) on sexual satisfaction among heterosexual men.
    MeSH terms: Adult; Breathing Exercises*; Humans; Malaysia; Male; Marriage*; Mental Health; Middle Aged; Personal Satisfaction*; Surveys and Questionnaires; Case-Control Studies; Treatment Outcome; Heterosexuality; Muscle Stretching Exercises*; Young Adult; Reproductive Health*
  10. Siow SL, Mahendran HA, Hardin M, Chea CH, Nik Azim NA
    Asian J Surg, 2013 Apr;36(2):64-8.
    PMID: 23522757 DOI: 10.1016/j.asjsur.2012.11.004
    Using laparoscopic methods for incarcerated scrotal hernias is controversial because of the perceived technical difficulties in treating such hernias. Herein, we present our experience with laparoscopic repair of such hernias.
    MeSH terms: Adult; Aged; Genital Diseases, Male/surgery*; Hernia, Inguinal/surgery*; Humans; Male; Middle Aged; Laparoscopy/methods*; Retrospective Studies; Scrotum*; Herniorrhaphy/methods*
  11. Lim KT, Hanifah YA, Mohd Yusof MY, Ito T, Thong KL
    J Microbiol Immunol Infect, 2013 Jun;46(3):224-33.
    PMID: 23523045 DOI: 10.1016/j.jmii.2013.02.001
    Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) continue to be a problem for clinicians worldwide. The objective of this study was to determine the changes in antibiograms of MRSA and their genotypic characteristics.
    MeSH terms: Bacterial Toxins/genetics; Chromosomes, Bacterial; Cross Infection/microbiology*; Cross Infection/epidemiology; Exotoxins/genetics; Genotype; Humans; Leukocidins/genetics; Malaysia/epidemiology; Microbial Sensitivity Tests; Staphylococcal Infections/microbiology*; Staphylococcal Infections/epidemiology; Polymerase Chain Reaction; Electrophoresis, Gel, Pulsed-Field; Sequence Analysis, DNA; Molecular Epidemiology; Drug Resistance, Multiple, Bacterial*; Methicillin-Resistant Staphylococcus aureus/drug effects*; Methicillin-Resistant Staphylococcus aureus/isolation & purification; Molecular Typing*; Tertiary Care Centers
  12. Aklilu E, Zunita Z, Hassan L, Cheng CH
    Vet Microbiol, 2013 Jun 28;164(3-4):352-8.
    PMID: 23523336 DOI: 10.1016/j.vetmic.2013.02.030
    In this study, we report the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) among veterinary students and personnel in Malaysia. Nasal and oral swabs were collected from 103 veterinary medicine students and 28 personnel from a veterinary hospital. Antibiotic sensitivity test (AST), minimum inhibitory concentration (MIC) test, and PCR amplifications of nucA and mecA gene were performed. Molecular characterization of the isolates was conducted using multilocus sequence typing (MLST), staphylococcal protein A gene (spa) typing, and pulsed-field gel electrophoresis (PFGE). Results from MLST show the presence of the pandemic and widespread MRSA clones, ST5 and ST59. Spa gene typing revealed spa type t267 which has a wide geographical distribution. A new spa type, t5697 was found in this study. Fingerprint analysis by using PFGE show heterogeneity of the isolates. These findings affirm the importance of MRSA in veterinary settings and underscore the need for further extensive research to devise contextual control and prevention strategies.
    MeSH terms: Animals; Anti-Bacterial Agents/pharmacology; Genes, Bacterial/genetics; Hospitals, Animal/statistics & numerical data*; Malaysia/epidemiology; Medical Staff/statistics & numerical data*; Microbial Sensitivity Tests; Staphylococcal Infections/genetics; Staphylococcal Infections/microbiology; Staphylococcal Infections/epidemiology*; Students/statistics & numerical data*; Bacterial Typing Techniques; Prevalence; Electrophoresis, Gel, Pulsed-Field; Molecular Epidemiology*; Methicillin-Resistant Staphylococcus aureus/classification; Methicillin-Resistant Staphylococcus aureus/drug effects; Methicillin-Resistant Staphylococcus aureus/genetics; Methicillin-Resistant Staphylococcus aureus/physiology*; Multilocus Sequence Typing
  13. Alyousefi NA, Mahdy MA, Xiao L, Mahmud R, Lim YA
    Exp Parasitol, 2013 Jun;134(2):141-7.
    PMID: 23523861 DOI: 10.1016/j.exppara.2013.03.001
    Giardia duodenalis is an important intestinal protozoan in Yemen with infection rates ranging from 18% to 27%. To date, there has been no genotyping study to provide a better understanding of the transmission dynamic. This study was conducted to genotype and subtype G. duodenalis in Yemen. Stool samples were collected from 503 Yemeni outpatients between 1 and 80 years old, including 219 males and 284 females. Giardia cysts were detected via microscopy after the formal-ether concentration. Genotyping of Giardia was carried out using PCR and sequence analysis of the 16s rRNA and b-giardin genes. Of the 89 microscopy-positive Giardia samples, 65 were successfully sequenced, of which 66% (43 of 65) were identified as G. duodenalis assemblage A and 34% (22 of 65) as assemblage B. Further subtyping analysis based on b-giardin gene identified the presence of subtypes A2 and A3, which belong to the anthroponotic sub-assemblage AII. Data of the study suggest that anthroponotic transmission played a potential role in the transmission of giardiasis in the community. However, further genotyping and subtyping studies of specimens from humans and animals living in the same households are needed for a more definitive understanding of giardiasis transmission in Yemen.
    MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Base Sequence; Child; Child, Preschool; Cytoskeletal Proteins/genetics; Feces/parasitology; Female; Genotype; Giardiasis/epidemiology; Giardiasis/parasitology*; Giardiasis/transmission; Humans; Infant; Male; Middle Aged; Molecular Sequence Data; Phylogeny; Socioeconomic Factors; Yemen/epidemiology; Protozoan Proteins/genetics; DNA, Protozoan/chemistry; Sequence Alignment; Giardia lamblia/classification*; Giardia lamblia/genetics*; Giardia lamblia/isolation & purification; Young Adult; Genotyping Techniques
  14. Osman WH, Abdullah SR, Mohamad AB, Kadhum AA, Rahman RA
    J Environ Manage, 2013 May 30;121:80-6.
    PMID: 23524399 DOI: 10.1016/j.jenvman.2013.02.005
    A lab-scale granular activated carbon sequencing batch biofilm reactor (GAC-SBBR), a combined adsorption and biological process, was developed to treat real wastewater from a recycled paper mill. In this study, one-consortia of mixed culture (4000-5000 mg/L) originating from recycled paper mill activated sludge from Kajang, Malaysia was acclimatized. The GAC-SBBR was fed with real wastewater taken from the same recycled paper mill, which had a high concentration of chemical oxygen demand (COD) and adsorbable organic halides (AOX). The operational duration of the GAC-SBBR was adjusted from 48 h to 24, 12 and finally 8 h to evaluate the effect of the hydraulic retention time (HRT) on the simultaneous removal of COD and AOX. The COD and AOX removals were in the range of 53-92% and 26-99%, respectively. From this study, it was observed that the longest HRT (48 h) yielded a high removal of COD and AOX, at 92% and 99%, respectively.
    MeSH terms: Charcoal/chemistry; Hydrocarbons, Halogenated/isolation & purification*; Paper; Water Pollutants, Chemical/isolation & purification*; Bioreactors; Biological Oxygen Demand Analysis; Waste Water/chemistry*
  15. Kura AU, Hussein Al Ali SH, Hussein MZ, Fakurazi S, Arulselvan P
    Int J Nanomedicine, 2013;8:1103-10.
    PMID: 23524513 DOI: 10.2147/IJN.S39740
    A new layered organic-inorganic nanocomposite material with an anti-parkinsonian active compound, L-3-(3,4-dihydroxyphenyl) alanine (levodopa), intercalated into the inorganic interlayers of a Zn/Al-layered double hydroxide (LDH) was synthesized using a direct coprecipitation method. The resulting nanocomposite was composed of the organic moiety, levodopa, sandwiched between Zn/Al-LDH inorganic interlayers. The basal spacing of the resulting nano-composite was 10.9 Å. The estimated loading of levodopa in the nanocomposite was approximately 16% (w/w). A Fourier transform infrared study showed that the absorption bands of the nanocomposite were characteristic of both levodopa and Zn/Al-LDH, which further confirmed intercalation, and that the intercalated organic moiety in the nanocomposite was more thermally stable than free levodopa. The resulting nanocomposite showed sustained-release properties, so can be used in a controlled-release formulation. Cytotoxicity analysis using an MTT assay also showed increased cell viability of 3T3 cells exposed to the newly synthesized nanocomposite compared with those exposed to pure levodopa after 72 hours of exposure.
    MeSH terms: Aluminum/chemistry; Animals; Antiparkinson Agents/administration & dosage; Antiparkinson Agents/pharmacokinetics; Antiparkinson Agents/chemistry*; Cell Survival/drug effects; Drug Carriers/administration & dosage; Drug Carriers/pharmacokinetics; Drug Carriers/chemistry*; Hydrogen-Ion Concentration; Hydroxides/chemistry; Levodopa/administration & dosage; Levodopa/pharmacokinetics; Levodopa/chemistry*; Chemical Precipitation; Surface Properties; Zinc/chemistry; 3T3 Cells; Mice; Nanocomposites/chemistry*
  16. Nagandla K, De S
    Postgrad Med J, 2013 Jul;89(1053):402-10.
    PMID: 23524988 DOI: 10.1136/postgradmedj-2012-131634
    Restless legs syndrome (RLS) is a common sensory motor neurological disorder that is characterised by an irresistible urge to move the legs that significantly affects the quality of life of the patient. Prevalence in the general population is 5-25% and it is twice as prevalent in women as in men. RLS is the most common movement disorder in pregnancy with a fourfold increased risk of developing this disorder later in life. The pathophysiology of RLS is centred on dopaminergic dysfunction, reduced central nervous system iron, genetic linkages, or alteration in neurotransmitters such as hypocretins, endorphins levels and immune dysfunction and inflammatory mechanisms. With the emergence of new evidence, there are changes to the previous treatment recommendations for RLS. There is sufficient evidence to conclude that dopamine agonists such as rotigotine transdermal patch, pramipexole, ropinirole, gabapentin enacarbil, pregabalin and gabapentin are effective in the short-term treatment of RLS and rotigotine, followed by gabapentin enacarbil, ropinirole, pramipexole and gabapentin for long-term treatment. Based on expert consensus, the recommendation for daily RLS is dopamine agonists or gabapentin or low-potency opioids. Levodopa is less preferred for treating daily RLS due to its high risk of augmentation. For intermittent RLS, it is levodopa or dopamine agonists or low-potency opioids or benzodiazepines. For refractory RLS, the choice is to change to gabapentin or a different dopamine agonist, addition of a second agent like gabapentin or benzodiazepine to the existing drug or changing to a high-potency opioid or tramadol. Medications with safety record in pregnancy include opioids and antiepileptics such as carbamazepine and gabapentin. There are concerns that patients with RLS are at risk for metabolic deregulation, autonomic dysfunction and cardiovascular morbidity. However, a recent study concluded that RLS is not associated with increased risk of cardiovascular complications.
    MeSH terms: Orexins; Amines/therapeutic use; Anemia/diagnosis; Anemia/physiopathology*; Anticonvulsants/therapeutic use; Cyclohexanecarboxylic Acids/therapeutic use; Diagnosis, Differential; Female; gamma-Aminobutyric Acid/therapeutic use; Humans; Genetic Linkage; Male; Neuropeptides/blood; Paresthesia/diagnosis; Paresthesia/drug therapy; Paresthesia/physiopathology*; Paresthesia/psychology; Pregnancy; Pregnancy Complications/diagnosis; Pregnancy Complications/drug therapy; Pregnancy Complications/physiopathology*; Pregnancy Complications/psychology; Quality of Life; Restless Legs Syndrome/diagnosis; Restless Legs Syndrome/drug therapy; Restless Legs Syndrome/physiopathology*; Restless Legs Syndrome/psychology; Prevalence; Dopamine Agonists/therapeutic use*; Intracellular Signaling Peptides and Proteins/blood
  17. Loch A, Lwin T, Zakaria IM, Abidin IZ, Wan Ahmad WA, Hautmann O
    Postgrad Med J, 2013 Jun;89(1052):335-9.
    PMID: 23524989 DOI: 10.1136/postgradmedj-2012-131174
    INTRODUCTION: Achieving target door-needle times for ST elevation myocardial infarction remains challenging. Data on emergency department (ED) doctor-led thrombolysis in developing countries and factors causing delay are limited.
    OBJECTIVES: To assess the effect on door-needle times by transferring responsibility for thrombolysis to the ED doctors and to identify predictors of prolonged door-needle times.
    METHODOLOGY: Data on medical on-call team-led thrombolysis at a tertiary Asian hospital were prospectively collected from May 2007 to Aug 2008 (1st study period). In September 2008, ED doctors were empowered to perform thrombolysis. The practice change was accompanied by new guidelines, tick chart implementation, and training sessions. Data were then consecutively collected from September 2008 to May 2009 (2nd study period). Door-to-needle times for the 1st and 2nd study periods were compared. All cases were analysed for factors of delay by multiple logistic regression.
    RESULTS: 297 patients were thrombolysed, 169 by the medical on-call team during the 1st study period and 128 by the ED doctors during the 2nd study period. Median door-needle times were 54 and 48 min, respectively (p=0.76). Significant delays were predicted by 'incorrect initial ECG interpretation' (adjusted OR (aOR) 14.3), 'inappropriate triage' (aOR 10.4) and 'multiple referrals' (aOR 5.9). No cases of inappropriate thrombolysis were recorded.
    CONCLUSIONS: Transfer of responsibility for thrombolysis to the ED doctors did not improve door-needle times despite measures introduced to facilitate this change. Key causative factors for this failure were identified.
    KEYWORDS: Accident & Emergency Medicine; Quality improvement
    Study site: Emergency department, University Malaya Medical Centre, Kuala Lumpur
    MeSH terms: Adult; Aged; Aged, 80 and over; Decision Making; Developing Countries; Emergency Medical Services/standards*; Emergency Service, Hospital; Female; Hospitals, University; Humans; Malaysia/epidemiology; Male; Middle Aged; Myocardial Infarction/mortality; Myocardial Infarction/therapy*; Patient Admission; Pilot Projects; Triage/standards*; Treatment Outcome; Practice Guidelines as Topic; Guideline Adherence; Quality Indicators, Health Care; Percutaneous Coronary Intervention/standards*
  18. Chin KY, Soelaiman IN, Mohamed IN, Ahmad F, Ramli ES, Aminuddin A, et al.
    Clinics (Sao Paulo), 2013;68(2):159-66.
    PMID: 23525310
    OBJECTIVES: Variations in the prevalence of sex-hormone-related diseases have been observed between Asian ethnic groups living in the same country; however, available data concerning their sex hormone levels are limited. The present study aimed to determine the influence of ethnicity and age on the sex hormone levels of Malay and Chinese men in Malaysia.

    METHODS: A total of 547 males of Malay and Chinese ethnicity residing in the Klang Valley Malaysia underwent a detailed screening, and their blood was collected for sex hormones analyses.

    RESULTS: Testosterone levels were normally distributed in the men (total, free and non-sex hormone-binding globulin (SHBG) bound fractions), and significant ethnic differences were observed (p<0.05); however, the effect size was small. In general, testosterone levels in males began to decline significantly after age 50. Significant ethnic differences in total, free and non-SHBG bound fraction estradiol levels were observed in the 20-29 and 50-59 age groups (p<0.05). The estradiol levels of Malay men decreased as they aged, but they increased for Chinese men starting at age 40.

    CONCLUSIONS: Small but significant differences in testosterone levels existed between Malay and Chinese males. Significant age and race differences existed in estradiol levels. These differences might contribute to the ethnic group differences in diseases related to sex hormones, which other studies have found in Malaysia.

    MeSH terms: Adult; Age Factors; Aged; Enzyme-Linked Immunosorbent Assay; Epidemiologic Methods; Estradiol/blood*; Ethnic Groups/ethnology; Ethnology; Humans; Malaysia/ethnology; Male; Middle Aged; Sex Hormone-Binding Globulin/analysis*; Testosterone/blood*; Age Distribution; Asian Continental Ancestry Group*; Young Adult
  19. Ng ZX, Chua KH, Tajunisah I, Pendek R, Kuppusamy UR
    Clinics (Sao Paulo), 2013;68(2):185-93.
    PMID: 23525314 DOI: 10.6061/clinics/2013(02)oa11
    OBJECTIVE: This study aimed to assess the circulating levels of activated nuclear factor kappa B p65 and monocyte chemotactic protein-1 in diabetic retinopathy patients who were taking antihyperglycemic and antihypertensive drugs.

    METHODS: In total, 235 healthy controls and 371 Type 2 diabetic patients [171 without retinopathy (DNR) and 200 patients with retinopathy (diabetic retinopathy)] were recruited for this study. Plasma and the nuclear fraction of peripheral blood mononuclear cells were isolated for the quantification of the monocyte chemotactic protein-1 and nuclear factor kappa B p65 levels, respectively.

    RESULTS: Non-medicated diabetic retinopathy patients had significantly higher levels of activated nuclear factor kappa B p65 and plasma monocyte chemotactic protein-1 than DNR patients. Diabetic retinopathy patients who were taking antihyperglycemic and antihypertensive drugs showed significant reductions in both the nuclear factor kappa B p65 and monocyte chemotactic protein-1 levels compared with the non-medicated patients.

    CONCLUSION: This study demonstrated the significant attenuation of both the nuclear factor kappa B p65 and circulating monocyte chemotactic protein-1 levels in diabetic retinopathy patients taking antihyperglycemic and antihypertensive drugs.
    MeSH terms: Adult; Aged; Analysis of Variance; Antihypertensive Agents/therapeutic use; Diabetic Retinopathy/blood*; Diabetic Retinopathy/drug therapy*; Female; Humans; Hypoglycemic Agents/therapeutic use; Male; Middle Aged; Risk Factors; Biomarkers/blood; Case-Control Studies; Risk Assessment; Chemokine CCL2/blood*; Transcription Factor RelA/blood*
  20. Zin SR, Omar SZ, Khan NL, Musameh NI, Das S, Kassim NM
    Clinics (Sao Paulo), 2013;68(2):253-62.
    PMID: 23525324
    OBJECTIVES: Genistein is known to influence reproductive system development through its binding affinity for estrogen receptors. The present study aimed to further explore the effect of Genistein on the development of the reproductive system of experimental rats.

    METHODS: Eighteen post-weaning female Sprague Dawley rats were divided into the following groups: (i) a control group that received vehicle (distilled water and Tween 80); (ii) a group treated with 10 mg/kg body weight (BW) of Genistein (Gen 10); and (iii) a group treated with a higher dose of Genistein (Gen 100). The rats were treated daily for three weeks from postnatal day 22 (P22) to P42. After the animals were sacrificed, blood samples were collected, and the uteri and ovaries were harvested and subjected to light microscopy and immunohistochemical study.

    RESULTS: A reduction of the mean weekly BW gain and organ weights (uteri and ovaries) were observed in the Gen 10 group compared to the control group; these findings were reversed in the Gen 100 group. Follicle stimulating hormone and estrogen levels were increased in the Gen 10 group and reduced in the Gen 100 group. Luteinizing hormone was reduced in both groups of Genistein-treated animals, and there was a significant difference between the Gen 10 and control groups (p<0.05). These findings were consistent with increased atretic follicular count, a decreased number of corpus luteum and down-regulation of estrogen receptors-a in the uterine tissues of the Genistein-treated animals compared to the control animals.

    CONCLUSION: Post-weaning exposure to Genistein could affect the development of the reproductive system of ovarian-intact experimental rats because of its action on the hypothalamic-pituitary-gonadal axis by regulating hormones and estrogen receptors.

    MeSH terms: Animals; Body Weight; Estrogens/blood; Female; Follicle Stimulating Hormone; Luteinizing Hormone/blood; Organ Size/drug effects; Ovary/drug effects*; Time Factors; Uterus/drug effects*; Rats, Sprague-Dawley; Genistein/administration & dosage; Genistein/pharmacology*; Phytoestrogens/administration & dosage; Phytoestrogens/pharmacology*; Rats
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