Browse publications by year: 2016

Fulltext Ebola virus disease: How can African pharmacists respond to future outbreaks?

James PB, Jamshed SQ, Patel I

Asian Pac J Trop Dis, 2016 May;6(5):337-338.
PMID: 32289032 DOI: 10.1016/S2222-1808(15)61041-6

In its forty years history (1976-2016), the West African region has recorded the most devastating form of the Ebola virus disease. The sparse knowledge of healthcare professionals and general public combined with lesser responses from international community are major factors for the dissemination of the disease. In the context of this outbreak, there is a need to highlight the roles and responsibilities of pharmacists, especially in the African healthcare setting. Moreover, the prerequisite of diagnostic kits for the timely detection of the infection as well as pharmacists' awareness of the current therapeutic regimen are recommended.
Gallium-containing mesoporous bioactive glass with potent hemostatic activity and antibacterial efficacy

Pourshahrestani S, Zeimaran E, Adib Kadri N, Gargiulo N, Samuel S, Naveen SV, et al.

J Mater Chem B, 2016 Jan 07;4(1):71-86.
PMID: 32262810 DOI: 10.1039/c5tb02062j

Haemorrhage remains the leading cause of potentially survivable death in both military and civilian populations. Although a large variety of hemostatic agents have been developed, many of them have an inadequate capacity to induce hemostasis and are not effective in killing bacteria. In recent years, mesoporous bioactive glasses (MBGs) were found to be effective in inducing hemostasis. However, the materials may not be considered as ideal hemostats since they do not offer antimicrobial activity. The gallium ion (Ga+3) not only exhibits antibacterial properties but also accelerates the blood coagulation cascade. The aim of this study was to develop MBGs containing various concentrations of Ga2O3 (1, 2 & 3 mol%) via the evaporation-induced self-assembly (EISA) process and investigate whether the addition of Ga3+ would induce both hemostatic and antibacterial effects. The results indicated that the incorporation of lower Ga2O3 content (1 mol%) into the MBG system improved structural properties including the specific surface area, mesopore size and pore volume as well as the release of silicon and calcium ions. The bioactive glass was found to stimulate blood coagulation, platelet adhesion and thrombus generation and exerted an antibacterial effect against both Escherichia coli and Staphylococcus aureus. Likewise, Ga-doped MBGs showed excellent cytocompatibility even after 3 days, with the 1% Ga2O3-containing MBG attaining the best biocompatibility that render them safe hemostatic agents for stopping bleeding. This study demonstrated that the lowest Ga2O3-substituted MBG can be a potent candidate for controlling haemorrhage and wound infection.
Fulltext A transmission electron microscopy study of anticoagulant-induced platelet vesiculation

Almhanawi BH, Khalid B, Ibrahim TA, Tohit ERM

Porto Biomed J, 2016 12 27;2(1):23-27.
PMID: 32258580 DOI: 10.1016/j.pbj.2016.11.002

Highlights: EDTA induces platelet microparticles (PMPs) vesiculation.Sodium citrated tubes are better than EDTA tubes in PMPs analysis.Sodium citrate has a minor impact on platelet structure.
Abstract: Platelet microparticles (PMPs) are small membrane fragments released from activated platelets in response to various stimuli. PMPs serve as biomarkers for several diseases and conditions and are useful tools for prognostic, diagnostic, and therapeutic purposes. The objective of our study was to compare the direct effects of ethylenediaminetetraacetic acid (EDTA) and sodium citrate anticoagulants on platelet structure and PMP vesiculation using transmission electron microscopy to visualize the morphologic changes in platelets. Micrographs revealed that platelets in the EDTA-anticoagulated tube manifested with significant morphologic changes and induced PMP vesiculation. On the other hand, the sodium citrate-anticoagulated tube showed a normal platelet structure and minor modifications in some cases, with poor indication of PMP vesiculation. In conclusion, EDTA induced platelet activation and PMP vesiculation and represents a major source of artifacts during the pre-analysis steps of PMP vesiculation.
Fulltext Vaccine Development Against Middle East Respiratory Syndrome

Lee HY, Nyon MP, Strych U

Curr Trop Med Rep, 2016;3(3):80-86.
PMID: 32226714 DOI: 10.1007/s40475-016-0084-0

Various types of vaccines are under pre-clinical and clinical development to address the recent appearance of Middle East respiratory syndrome or MERS, an emerging infectious disease that has already caused over 600 deaths and remains a threat to world health. The causative agent for this respiratory disease is a member of the betacoronavirus genus, phylogenetically closely related to the SARS coronavirus that caused an international health emergency in 2002. With lessons learned from the outbreak of severe acute respiratory syndrome, and with undeniable technological advances, vaccine development against MERS was initially fast-paced and has produced several DNA and protein vaccine candidates with promising results during early pre-clinical testing. At least one vaccine candidate has even entered first-in-humans clinical trials now. With the number of MERS cases declining though and other infectious diseases attracting increased attention, the question remains, whether, similar to the situation after the SARS pandemic, vaccine development is halted or remains the priority it rightfully should.
Fulltext Nano-capillary electrophoresis for environmental analysis

Ali I, Alharbi OML, Marsin Sanagi M

Environ Chem Lett, 2016;14(1):79-98.
PMID: 32214934 DOI: 10.1007/s10311-015-0547-x

Many analytical techniques have been used to monitor environmental pollutants. But most techniques are not capable to detect pollutants at nanogram levels. Hence, under such conditions, absence of pollutants is often assumed, whereas pollutants are in fact present at low but undetectable concentrations. Detection at low levels may be done by nano-capillary electrophoresis, also named microchip electrophoresis. Here, we review the analysis of pollutants by nano-capillary electrophoresis. We present instrumentations, applications, optimizations and separation mechanisms. We discuss the analysis of metal ions, pesticides, polycyclic aromatic hydrocarbons, explosives, viruses, bacteria and other contaminants. Detectors include ultraviolet-visible, fluorescent, conductivity, atomic absorption spectroscopy, refractive index, atomic fluorescence spectrometry, atomic emission spectroscopy, inductively coupled plasma, inductively coupled plasma-mass spectrometry, mass spectrometry, time-of-flight mass spectrometry and nuclear magnetic resonance. Detection limits ranged from nanogram to picogram levels.
Management of Patient Care in Hemodialysis While Focusing on Cardiovascular Disease Events and the Atypical Role of Hyper- and/or Hypotension: A Systematic Review

Khan A, Khan AH, Adnan AS, Syed Sulaiman SA, Gan SH, Khan I

Biomed Res Int, 2016;2016:9710965.
PMID: 27833921

Background. Hemodialysis related hemodynamic instability is a major but an underestimated issue. Moreover, cardiovascular events are the leading cause of morbidity and mortality associated with blood pressure in hemodialysis patients. However, there have been many controversies regarding the role and management of hyper- and/or hypotension during hemodialysis that needs to be addressed. Objective. To critically review the available published data on the atypical role of hyper- and/or hypotension in cardiovascular associated morbidity and mortality in patients on hemodialysis and to understand the discrepancies in this context. Methods. A comprehensive search of literature employing electronic as well as manual sources and screening 2783 papers published between Jan 1980 and Oct 2015 was conducted to collect, identify, and analyze relevant information through peer-reviewed research articles, systematic reviews, and other published works. The cardiovascular events, including accelerated atherosclerotic cardiovascular disease (ASCVD), stroke, heart failure, myocardial infarction, myocardial ischemia, and stress induced myocardial dysfunction, leading to death were considered relevant. Results. A total of 23 published articles met the inclusion criteria and were included for in-depth review and analysis to finalize a comprehensive systematic review article. All the studies showed a significant association between the blood pressure and cardiovascular disease events in hemodialysis patients. Conclusions. Both intradialytic hypertension/hypotension episodes are major risk factors for cardiovascular mortality with a high percentage of probable causality; however, clinicians are faced with a dilemma on how to evaluate blood pressure and treat this condition.

MeSH terms: Blood Pressure; Cardiovascular Diseases/etiology; Cardiovascular Diseases/mortality; Cardiovascular Diseases/physiopathology*; Renal Dialysis/adverse effects*; Humans; Hypertension/etiology; Hypertension/mortality; Hypertension/physiopathology*; Hypotension/etiology; Hypotension/mortality; Hypotension/physiopathology*
Fulltext KOSPEN: Challenges in empowering the community [Abstract]

Ramly R

Malaysian Journal of Public Health Medicine, 2016;16 Suppl 4:7-8.

The prevalence of Non Communicable Diseases (NCD) and its risk factors among Malaysian adults are still high. National Health Morbidity Survey (NHMS) 2015 shows that 17.5% of Malaysian adults have diabetes, out of which 53% are undiagnosed, 30.3% are hypertensive whereby 57% of them were undiagnosed. 1 in every 2 Malaysian adults is overweight or obese. Except for hypertension which prevalence is slightly lower compared to 2011 NHMS, all of these prevalences are increasing over the years in spite of vigorous efforts that have been conducted in educating and creating public awareness on the disease and its prevention and control. The increasing trend in NCD and its related risk factors have proved that the educational sensibility is not sufficient in prompting the adoption of healthy behaviors. Obstacles include lack of perceived priority for health, and lack of perceived priority for NCD within the health sector itself. NCD is very much associated with human behavior, environment, economic and social factors. Many studies and experiences have shown that carefully planned and fully implemented community-based intervention program play a big role in overcoming the problem of NCD. The intervention should consist of community and individual empowerment, environmental support and reorienting health services. In 2013, the ministry has taken a big step by embarking on a nationwide community based intervention program namely Komuniti Sihat Perkasa Negara (KOSPEN). This initiative brings the NCD prevention and control program to the community through trained health volunteers, who will function as health agent of change or health enablers that introduce and facilitate healthy living practices amongst their respective community members. This would serve as a mean to control NCD such as high blood pressure and diabetes and its associated risk factors such as obesity, unhealthy diet, smoking and sedentary life style within local communities Combining public education and efforts to prompt behavioral changes, KOSPEN is based on three main strategies which are advocacy and awareness, health policy adoption and establishment of healthy environments and routine NCD risk factors screenings. Trained volunteers are also capable of measuring blood pressure, blood glucose levels and body mass index (BMI) following which, at risk cases are referred to nearby health clinics for further confirmation and management. In addition to these, the volunteers who will be known as Gerak Sihat Malaysia (GSiM) are also trained to plan and organize related intervention programs at the community level for those who need it. As of May 2016, there is 5,000 KOSPEN localities nationwide with 30,000 volunteers trained. 300,000 adults have been screened for high Blood Pressure, at risk blood sugar level, overweight and smokers, out of which 70% have been referred to health clinics for Diabetic confirmation, 36% for high risk Blood Pressure and 6.5% for class II Obesity. In addition to this, weight management program is now being piloted in 134 KOSPEN localities. The Health Ministry is targeting as many as 10,000 KOSPEN localities and 50,000 GSiM by 2022. With this individual and community empowerment effort, almost six million citizens is estimated to get benefit from the program, while 1.6 million adults are expected to undergo NCD screening tests by KOSPEN volunteers.
8th National Public Health Conference 2016, Managing Society in Combating Public Health Challenges, 2-4 August 2016

MeSH terms: Malaysia; Patient Participation
Electrocatalytic Water Oxidation by a Tetranuclear Copper Complex

Praneeth VKK, Kondo M, Woi PM, Okamura M, Masaoka S

Chempluschem, 2016 Oct;81(10):1123-1128.
PMID: 31964085 DOI: 10.1002/cplu.201600322

A novel tetranuclear copper-based water oxidation catalyst was designed and synthesized by using a new multinucleating ligand containing two proton dissociation sites, 1,3-bis(6-hydroxy-2-pyridyl)-1H-pyrazole. The copper complex showed electrocatalytic activity for water oxidation reactions under aqueous basic conditions (pH 12.5) with an overpotential of approximately 500 mV. UV/Vis absorption and energy-dispersive X-ray (EDX) spectroscopic techniques coupled with electrochemical analyses of the catalyst system strongly suggest that the tetranuclear copper complex works as a homogeneous system under the conditions used. The results described here demonstrate the utility of a discrete tetranuclear copper complex in water oxidation reactions.
Fulltext Preliminary Taxonomic Survey and Molecular Documentation of Jellyfish Species (Cnidaria: Scyphozoa and Cubozoa) in Malaysia

Rizman-Idid M, Farrah-Azwa AB, Chong VC

Zool Stud, 2016;55:e35.
PMID: 31966180 DOI: 10.6620/ZS.2016.55-35

Mohammed Rizman-Idid, Abu Bakar Farrah-Azwa, and Ving Ching Chong (2016) Scientific enquiries into jellyfish blooms and associated problems are often deterred by the lack of taxonomical and ecological studies worldwide. Taxonomic difficulty is attributed to the high degree of morphological variations among and within species. To date, only two scyphozoan jellyfish species have been documented from field surveys in Malaysian waters, whereas another four Malaysian scyphozoan and two cubozoan jellyfish species have been mentioned in toxicological studies. None of these species have; however, been verified. This study thus aimed to document and resolves the uncertainty of earlier identified species in the region using morphology and molecular DNA sequencing. Jellyfish specimens were collected from Malaysian waters in the Straits of Malacca, South-China Sea and the Sulu-Sulawesi Sea over two years (June 2008 to October 2010), and their DNA sequences were compared with those from the Atlantic and Pacific regions. Ten scyphozoan and two cubozoan species were recorded in Malaysian waters (South China Sea and Straits of Malacca). These jellyfish included eight species from the order Rhizostomeae (Rhizostomatidae, Lobonematidae, Mastigiidae, Catostylidae and Cepheidae), two species from Semaestomeae (Pelagiidae and Cyaneidae) and two species from class Cubozoa; one from order Carybdeida (family Carukiidae) and another from order Chirodropida (family Chiropsalmidae). Molecular identification of species using phylogenetic approaches was based on DNA sequences of partial cytochrome oxidase I (COI), 16S and internal transcribed spacer (ITS1) regions. The COI phylogenetic tree of Cubozoa and Scyphozoa species from the Atlantic and Pacific regions showed distinct clustering of six Malaysian jellyfish species. However, most of the deeper divergences and relationships between the families were unresolved, which were also observed in the 16S and ITS1 phylogenetic trees. The Malaysian edible species Lobonemoides robustus, Rhopilema hispidum and Rhopilema esculentum were grouped within Rhizostomeae, whereas other scyphozoans showed phylogenetic affinities to Semaestomeae and Kolpophorae. Chrysaora and Cyanea appeared non-monophyletic; however their paraphyly was not confirmed. This study has provided the much needed baseline information on the taxonomy of Malaysian jellyfish species which have been substantiated by partial COI, 16S and ITS1 sequences. A total of 12 putative species of jellyfish were identified, which encompassed 12 genera.
Fulltext Growth, Diet Composition and Reproductive Biology of the Invasive Freshwater Fish Chevron snakehead Channa striata on a Subtropical Island

Li KC, Shieh BS, Chiu YW, Huang DJ, Liang SH

Zool Stud, 2016;55:e53.
PMID: 31966198 DOI: 10.6620/ZS.2016.55-53

Kuan-chung Li, Bao-sen Shieh, Yuh-wen Chiu, Da-ji Huang, and Shih-hsiung Liang (2016) The Chevron snakehead (Channa striata) has been invading Taiwan for over 30 years, and it is currently widely distributed across diverse aquatic habitats within the island. Due to its strong environmental adaptability and carnivorous diet, C. striata has caused great negative impacts to the biodiversity of native fishes and aquatic organisms in Taiwan. To effectively restrain its spatial distribution and population, the objective of this study was to investigate the growing conditions, diet composition, and reproductive biology of C. striata in the field. In total, 294 individuals were collected from wetlands, irrigation canals, streams, and reservoirs in southern Taiwan from September 2008 to December 2010. Among 272 sex-identified individuals, more females (164) were collected than males (108). The morphological differences between the sexes could not be distinguished by the 10 body measurements recorded. Diverse food items, including snails, odonates, fishes, amphibians, and reptiles, were identified in the stomachs of 35 individuals. The minimum body length of sexually mature C. striata females exhibited at a standard length of 24.5 cm (total length 28 cm). The appearance of mature oocytes were mainly observed from July to November in 2009 and from April to October in 2010. Greater absolute fecundity (oocyte/individual) was estimated in Taiwan for C. striata than in its original distribution range possibly due to less water level fluctuation in the sampling habitats of Taiwan. The relative fecundity (oocyte/g) for C. striata was considered lower but within the documented range in Taiwan when compared with its original habitat in Malaysia. To effectively manage C. striata in Taiwan, regionally eradiating young and adult individuals, especially during the reproductive season and educating people to stop releasing it in the wild are possible ways to restrain and control the further spread of this exotic fish in Taiwan.
Simian immunodeficiency virus SIVmac239 infection and simian human immunodeficiency virus SHIV89.6P infection result in progression to AIDS in cynomolgus macaques of Asian origin

Okamura T, Tsujimura Y, Soma S, Takahashi I, Matsuo K, Yasutomi Y

J Gen Virol, 2016 Dec;97(12):3413-3426.
PMID: 27902330 DOI: 10.1099/jgv.0.000641

Simian immunodeficiency virus (SIV) infection models in cynomolgus macaques are important for analysis of the pathogenesis of immunodeficiency virus and for studies on the efficacy of new vaccine candidates. However, very little is known about the pathogenesis of SIV or simian human immunodeficiency virus (SHIV) in cynomolgus macaques from different Asian countries. In the present study, we analysed the infectivity and pathogenicity of CCR5-tropic SIVmac and those of dual-tropic SHIV89.6P inoculated into cynomolgus macaques in Indonesian, Malaysian or Philippine origin. The plasma viral loads in macaques infected with either SIVmac239 or SHIV89.6P were maintained at high levels. CD4+ T cell levels in macaques infected with SIVmac239 gradually decreased. All of the macaques infected with SHIV89.6P showed greatly reduced CD4+ T-cell numbers within 6 weeks of infection. Eight of the 11 macaques infected with SIVmac239 were killed due to AIDS symptoms after 2-4.5 years, while four of the five macaques infected with SHIV89.6P were killed due to AIDS symptoms after 1-3.5 years. We also analysed cynomolgus macaques infected intrarectally with repeated low, medium or high doses of SIVmac239, SIVmac251 or SHIV89.6P. Infection was confirmed by quantitative RT-PCR at more than 5000, 300 and 500 TCID50 for SIVmac239, SIVmac251 and SHIV89.6P, respectively. The present study indicates that cynomolgus macaques of Asian origin are highly susceptible to SIVmac and SHIV infection by both intravenous and mucosal routes. These models will be useful for studies on virus pathogenesis, vaccination and therapeutics against human immunodeficiency virus/AIDS.

MeSH terms: Acquired Immunodeficiency Syndrome/pathology; Acquired Immunodeficiency Syndrome/virology*; Animals; Asia; Disease Models, Animal*; HIV/genetics; HIV/physiology*; Humans; Macaca fascicularis; Male; Simian Immunodeficiency Virus/genetics; Simian Immunodeficiency Virus/physiology*; CD4-Positive T-Lymphocytes/virology; Disease Progression; Viral Load
Progression of recurrent acute and chronic pancreatitis: A short-term follow up study from a southern Indian centre

Kamath MG, Pai CG, Kamath A

Indian J Gastroenterol, 2016 Nov;35(6):425-431.
PMID: 27783351

BACKGROUND: Little data exist on the progression of recurrent acute (RAP) and chronic pancreatitis (CP) from regions from where the entity of tropical chronic pancreatitis was originally described. The study aimed to follow up patients with RAP and CP seen at a southern Indian centre for progression of disease over time.
METHODS: Prospectively enrolled patients with RAP and CP were followed up, and the alcoholic and idiopathic subgroups were assessed for progression of structural and functional changes in the organ.
RESULTS: One hundred and forty patients (RAP = 44; 31.4 %, CP = 96; 68.5 %) were followed up over a median 12.2 (interquartile range 12.0-16.8) months. The cause was alcohol in 31 (22.1 %) and not evident in 109 (77.8 %). The disease progressed from RAP to CP in 7 (15.9 %), 6 (16.2 %) out of 37 in the idiopathic and 1 (14.2 %; p = 1.00) out of 7 in the alcoholic subgroups. Three (42.8 %) and 1 (14.2 %) developed steatorrhea and diabetes mellitus (DM), respectively, and 2 (4.5 %) developed calcification. Established CP progressed in 19 (19.7 %), 1 (1.0 %), 5 (5.2 %), 2 (2.0 %) and 11 (11.4 %) newly developed DM, steatorrhea, calcification and duct dilation during follow up. Among the idiopathic and alcoholic CP, disease progression was seen in 15 (20.8 %) out of 72 and 4 (16.6 %) out of 24 respectively.
CONCLUSIONS: Idiopathic RAP and CP progressed during the short-term follow up. This is similar to other etiological forms of pancreatitis, as described from elsewhere in the world.

MeSH terms: Acute Disease; Adolescent; Adult; Chronic Disease; Diabetes Mellitus/etiology; Female; Follow-Up Studies; Humans; India; Longitudinal Studies; Male; Prospective Studies; Recurrence; Time Factors; Disease Progression; Steatorrhea/etiology; Young Adult
Fulltext Short review: Implementation of biomedical ethics in Malaysia

Maisarah AS, Nurul Ajilah MK, Siti Amalina MR, Norazuroh MN

Health and the Environment Journal, 2016;7:54-76.

This literature review focuses on the implementation of biomedical ethics in Malaysia based on the government and institutional settings. Insights of the development of biomedical ethics and the responsible entities, particularly the clinical trials that become the emerging field of interest by the government to boost the biomedical research in Malaysia are provided. Some issues and their implications for research and ethical review process in Malaysia are also elucidated. The review indicates the advancement of policies by the government in implementing the biomedical ethics with some affairs that should be a matter to be concerned.
Keywords: Biomedical, ethics, implementation, standards, research ethic committee, good laboratory practice.

MeSH terms: Clinical Trials as Topic; Humans; Malaysia; Ethics, Research
Fulltext Ethical Professional Practice Guidelines

Citation:
Ethical Professional Practice Guidelines. Kuala Lumpur: Academy of Medicine Malaysia; 2016

MeSH terms: Ethics, Medical; Humans; Malaysia; Guidelines as Topic; Ethics, Research
Oblique Retro-Aortic Left Renal Vein and its Clinical Importance

Bhagavath P, Nayak BS, Monteiro NP, Kumar GP

Kathmandu Univ Med J (KUMJ), 2016 7 18;13(52):369-71.
PMID: 27423291

Kidneys are the organs that remove the waste products of the metabolic activities. A smooth blood flow to the kidneys is essential to maintain their function. Abnormalities of the renal vasculature may result not only in impairing the renal function but can lead to conditions like varicocele. During an autopsy of an adult male, we observed renal vascular variations. The left renal vein had a retro-aortic course before its termination into the inferior vena cava. It was joined with the inferior vena cava at the level of inferior mesenteric artery with an acute angle. The left testicular vein joined the left renal vein with an acute angle. The right kidney was supplied by two renal arteries. The knowledge about retro-aortic course of the left renal vein may be important during renal transplantation. The oblique course of left renal vein and the termination of left testicular vein into it with an acute angle may increase the chances of left sided varicocele.

MeSH terms: Autopsy; Humans; Kidney/blood supply; Male; Middle Aged; Renal Veins/abnormalities*; Renal Veins/pathology; Testis/blood supply; Vena Cava, Inferior
Fulltext Efficacy and safety of once-monthly injection of paliperidone palmitate in hospitalized Asian patients with acute exacerbated schizophrenia: an open-label, prospective, noncomparative study

Li H, Turkoz I, Zhang F

Neuropsychiatr Dis Treat, 2016;12:15-24.
PMID: 26730193 DOI: 10.2147/NDT.S83651

INTRODUCTION: This single-group, open-label, prospective, noncomparative, multicenter, Phase IV study explored the efficacy and tolerability of paliperidone palmitate (PP) in hospitalized patients with acute exacerbation of schizophrenia.

METHODS: Asian patients of either sex, between 18 and 65 years of age, diagnosed with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) with acute exacerbations within the previous 4 weeks, were enrolled. Intramuscular PP was initiated at doses of 150 milligram equivalent (mg eq) (day 1) and 100 mg eq (day 8), followed by a monthly maintenance dose between 75 mg eq and 150 mg eq (days 36 and 64). Primary efficacy endpoint was the change from baseline in the Positive and Negative Syndrome Scale (PANSS) total score (last-observation-carried-forward) at week 13.

RESULTS: Of the 212 enrolled patients, 152 (71.7%) completed the 13-week treatment; withdrawal of consent (24 [11.3%] patients) was the most common reason for study discontinuation. Mean (standard deviation) PANSS total score from baseline (90.0 [17.41]) improved significantly at day 4 (-6.1 [9.27]; 95% confidence interval: -7.38, -4.85; P<0.001) and week 13 endpoint (-23.9 [23.24]; 95% confidence interval: -27.10, -20.78; P<0.001). Similarly, the secondary endpoints (Clinical Global Impression-Severity, Physical and Social Performance, each PANSS subscale, and Marder factor scores) improved significantly from baseline to week 13 endpoint (P<0.001 for all). At week 13, 112/210 (53.3%) patients had a 40% improvement in the PANSS total score (responder rate), and 133/212 (62.7%) patients were ready for hospital discharge. Overall, 139 (65.6%) patients experienced at least one treatment-emergent adverse event (TEAE). Most common (>5%) TEAEs were hyperprolactinemia, constipation, nasopharyngitis, insomnia, increased weight, and tremor. Worsening of schizophrenia (3.3%) and sinus bradycardia (2.0%) were serious TEAEs; no deaths were reported.

CONCLUSION: PP was generally tolerable and efficacious in a hospital setting for the treatment of acute exacerbated schizophrenia with significant improvements in psychotic symptoms, social functioning, and severity of illness.

MeSH terms: Adult; China; Humans; Korea; Malaysia
Fulltext Synergistically Enhanced Electrocatalytic Performance of an N-Doped Graphene Quantum Dot-Decorated 3D MoS2-Graphene Nanohybrid for Oxygen Reduction Reaction

Vinoth R, Patil IM, Pandikumar A, Kakade BA, Huang NM, Dionysios DD, et al.

ACS Omega, 2016 Nov 30;1(5):971-980.
PMID: 31457177 DOI: 10.1021/acsomega.6b00275

Nitrogen-doped graphene quantum dots (N-GQDs) were decorated on a three-dimensional (3D) MoS2-reduced graphene oxide (rGO) framework via a facile hydrothermal method. The distribution of N-GQDs on the 3D MoS2-rGO framework was confirmed using X-ray photoelectron spectroscopy, energy dispersive X-ray elemental mapping, and high-resolution transmission electron microscopy techniques. The resultant 3D nanohybrid was successfully demonstrated as an efficient electrocatalyst toward the oxygen reduction reaction (ORR) under alkaline conditions. The chemical interaction between the electroactive N-GQDs and MoS2-rGO and the increased surface area and pore size of the N-GQDs/MoS2-rGO nanohybrid synergistically improved the ORR onset potential to +0.81 V vs reversible hydrogen electrode (RHE). Moreover, the N-GQDs/MoS2-rGO nanohybrid showed better ORR stability for up to 3000 cycles with negligible deviation in the half-wave potential (E 1/2). Most importantly, the N-GQDs/MoS2-rGO nanohybrid exhibited a superior methanol tolerance ability even under a high concentration of methanol (3.0 M) in alkaline medium. Hence, the development of a low-cost metal-free graphene quantum dot-based 3D nanohybrid with high methanol tolerance may open up a novel strategy to design selective cathode electrocatalysts for direct methanol fuel cell applications.
Fulltext Serological assessment of the establishment of herd immunity against measles in a health district in Malaysia

Hazlina Y, Marlindawati MA, Shamsuddin K

BMC Infect Dis, 2016 Dec 08;16(1):740.
PMID: 27931192

BACKGROUND: Malaysia still faces challenges optimizing resources to effectively eliminate measles through high immunization and herd immunity, with sporadic outbreaks of measles as evidence. The objective of this study is to determine the age-specific positive measles antibodies seroprevalence used for assessing the establishment of herd immunity against measles in different age groups. This is useful for identifying vulnerable age groups requiring supplementary immunization.

METHODS: A seroprevalence study was conducted among respondents aged 6-9 years, 15-24 years and 45-54 years attending government health clinics in Seremban between September 2014 and January 2015. A total of 1541 measles IgG antibody status were determined using ELISA technique (NovaTec Immundiagnostica GMBH) and assessment of establishment of herd immunity was based on indicators developed by Plans. Data on socio-demographic background as well as medical and medication history were also gathered.

RESULTS: Seropositive rate for all respondents were 87% (95% CI 85-89), while the rest had either indeterminate [6% (95% CI 5-7)] or negative titre [7% (95% CI 6-8)]. None of the factors analyzed except for age were significant predictors of positive measles antibodies. Seropositive rate differed by age with the highest rate seen in adults (94%; CI 92-96), followed by children (90%; 95% CI 87-94) and adolescents, and young adults (74%; 95% CI 70-78). Based on Plans' indicators, herd immunity was established in adults and children, but not in adolescents and young adults.

CONCLUSIONS: To tackle the most susceptible group in the present study, it is advisable to give booster vaccination to secondary school students and freshmen who enter colleges and universities in Malaysia.

MeSH terms: Adolescent; Ambulatory Care Facilities; Antibodies, Viral/blood; Child; Female; Humans; Immunization, Secondary; Malaysia; Malaysia/epidemiology; Male; Measles/immunology*; Measles/epidemiology*; Middle Aged; Seroepidemiologic Studies; Immunity, Herd*; Young Adult
Fulltext Knowledge and awareness regarding osteoporosis among multi ethnic people attending the orthopaedic clinic at Universiti Kebangsaan Malaysia Medical Centre

Zaris SNABSM, Ahmad MSB, Mohamed SZB, Shuid ANB, Mohamed INB, Mokhtar SAB

Malaysian Journal of Public Health Medicine, 2016;16(3):166-175.

Malaysia is a multi-ethnic country with an osteoporosis prevalence of 24.1% in 2005. Only few study reported on osteoporosis awareness. Aim of this study was to investigate the awareness and knowledge regarding osteoporosis among persons attending orthopaedic clinic at Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur. A total of 368 participants (male and female) aged 20 years old or older, was assessed using the Osteoporosis Questionnaire (OPQ). The mean total OPQ score was 1.7 (SD ± 3.08; range -5 to 9; maximum possible score 20). Subjects with family history of osteoporosis and high education level were found to have significantly higher OPQ scores (p<0.05). However, there was no significant difference (p>0.05) with respect to different age groups, gender, ethnicities, and menopausal status. The main source of osteoporosis knowledge was magazine/newspaper (45.9%). An overall low score indicates that new strategies to increase awareness of osteoporosis among the public is urgently required.

MeSH terms: Adult; Cross-Sectional Studies; Female; Hospitals, University; Humans; Health Knowledge, Attitudes, Practice; Malaysia; Male; Osteoporosis; Outpatient Clinics, Hospital
Subclinical memory dysfunction in Malaysian systemic lupus erythematosus patients: Association with clinical characteristics and disease activity – A pilot study

Mohd Said MS, Bin Shudim SS, Mohamad K, Shaharir SS, Kong NCT, Ali RA

Egyptian Rheumatologist, 2016;38:189-194.
DOI: 10.1016/j.ejr.2015.12.001

Aim of the work This work aimed to determine the frequency of subclinical memory dysfunction in a group of Malaysian systemic lupus erythematosus (SLE) patients and to study its relation to clinical characteristics, laboratory investigations and disease activity. Patients and methods Fifteen SLE patients attending the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and not known to have neuropsychiatric lupus were recruited. These patients were assessed using the Wechsler Memory Scale. Disease activity was assessed using the SLE disease activity index 2000 (SLEDAI-2K). Results The median age of the patients was 28 years (25–37 years) and they were 14 females and one male. Their median disease duration was 9.3 years (4.8–10 years). Their median SLEDAI-2K was 4 (0–6). Memory dysfunction was identified in 7/15 (46.7%) SLE patients and was significantly associated with lower serum thyroxine levels (median 12.27; 11.8–13.3 μg/dl) (p = 0.027) compared to those without memory impairment (15.48; 14.39–16.56 μg/dl). Auditory memory impairment was associated with the education level as the auditory memory index was significantly lower in patients with secondary education (n = 7, median 88; 86.5–91.5) compared to those who received tertiary education (n = 8, median 103; 97.5–119.5) (p = 0.025) while visual memory was influenced by disease duration (p = 0.016). There was no association between overall memory dysfunction and disease duration, number of relapses, clinical manifestations and SLEDAI-2K scores. Conclusion There is a high frequency of subclinical memory dysfunction among SLE patients. A remarkable association is present with lower thyroxine. Auditory memory impairment is related to the level of education and visual memory to disease duration. © 2015 The Authors

MeSH terms: Adult; Alkaline Phosphatase; Creatinine; Cross-Sectional Studies; Educational Status; Female; Hospitals, University; Humans; Hypothyroidism; Leukocyte Count; Lupus Erythematosus, Systemic*; Malaysia; Male; Prednisolone; Serology; Thyrotropin; Thyroxine; Age Distribution

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