Browse publications by year: 2016

Fulltext Immunodominant IgM and IgG Epitopes Recognized by Antibodies Induced in Enterovirus A71-Associated Hand, Foot and Mouth Disease Patients

Aw-Yong KL, Sam IC, Koh MT, Chan YF

PLoS One, 2016;11(11):e0165659.
PMID: 27806091 DOI: 10.1371/journal.pone.0165659

Enterovirus A71 (EV-A71) is one of the main causative agents of hand, foot and mouth disease (HFMD). Unlike other enteroviruses that cause HFMD, EV-A71 is more frequently associated with severe neurological complications and fatality. To date, no effective licensed antivirals are available to combat EV-A71 infection. Little is known about the immunogenicity of viral non-structural proteins in humans. Previous studies have mainly focused on characterization of epitopes of EV-A71 structural proteins by using immunized animal antisera. In this study, we have characterized human antibody responses against the structural and non-structural proteins of EV-A71. Each viral protein was cloned and expressed in either bacterial or mammalian systems, and tested with antisera by western blot. Results revealed that all structural proteins (VP1-4), and non-structural proteins 2A, 3C and 3D were targets of EV-A71 IgM, whereas EV-A71 IgG recognized all the structural and non-structural proteins. Sixty three synthetic peptides predicted to be immunogenic in silico were synthesized and used for the characterization of EV-A71 linear B-cell epitopes. In total, we identified 22 IgM and four IgG dominant epitopes. Synthetic peptide PEP27, corresponding to residues 142-156 of VP1, was identified as the EV-A71 IgM-specific immunodominant epitope. PEP23, mapped to VP1 41-55, was recognized as the EV-A71 IgG cross-reactive immunodominant epitope. The structural protein VP1 is the major immunodominant site targeted by anti-EV-A71 IgM and IgG antibodies, but epitopes against non-structural proteins were also detected. These data provide new understanding of the immune response to EV-A71 infection, which benefits the development of diagnostic tools, potential therapeutics and subunit vaccine candidates.

MeSH terms: Cell Line; Cloning, Molecular; Hand, Foot and Mouth Disease/immunology*; Humans; Immunoglobulin G/immunology; Immunoglobulin M/immunology; Peptides/chemical synthesis; Peptides/immunology; Peptides/chemistry; Immunodominant Epitopes/immunology*; Viral Nonstructural Proteins/genetics; Viral Nonstructural Proteins/immunology*; Enterovirus A, Human/immunology*; HEK293 Cells
Fulltext Development of Tat-Conjugated Dendrimer for Transdermal DNA Vaccine Delivery

Bahadoran A, Moeini H, Bejo MH, Hussein MZ, Omar AR

J Pharm Pharm Sci, 2016 Jul-Sep;19(3):325-338.
PMID: 27806247 DOI: 10.18433/J3G31Q

PURPOSE: In order to enhance cellular uptake and to facilitate transdermal delivery of DNA vaccine, polyamidoamine (PAMAM) dendrimers conjugated with HIV transactivator of transcription (TAT) was developed.

METHODS: First, the plasmid DNA (pIRES-H5/GFP) nanoparticle was formulated using PAMAM dendrimer and TAT peptide and then characterized for surface charge, particle size, DNA encapsulation and protection of the pIRES-H5/GFP DNA plasmid to enzymatic digestion. Subsequently, the potency of the TAT-conjugated dendrimer for gene delivery was evaluated through in vitro transfection into Vero cells followed by gene expression analysis including western blotting, fluorescent microscopy and PCR. The effect of the TAT peptide on cellular uptake of DNA vaccine was studied by qRT-PCR and flow cytometry. Finally, the ability of TAT-conjugated PAMAM dendrimer for transdermal delivery of the DNA plasmid was assessed through artificial membranes followed by qRT-PCR and flow cytometry.

RESULTS: TAT-conjugated PAMAM dendrimer showed the ability to form a compact and nanometre-sized polyplexes with the plasmid DNA, having the size range of 105 to 115 nm and a positive charge of +42 to +45 mV over the N/P ratio of 6:1(+/-). In vitro transfection analysis into Vero cells confirms the high potency of TAT-conjugated PAMAM dendrimer to enhance the cellular uptake of DNA vaccine. The permeability value assay through artificial membranes reveals that TAT-conjugated PAMAM has more capacity for transdermal delivery of the DNA compared to unmodified PAMAM dendrimer (P<0.05).

CONCLUSIONS: The findings of this study suggest that TAT-conjugated PAMAM dendrimer is a promising non-viral vector for transdermal use.This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

MeSH terms: Animals; Cercopithecus aethiops; Peptides/pharmacokinetics; Peptides/chemistry*; Polyamines/chemistry; Vero Cells; Gene Transfer Techniques*; Vaccines, DNA/genetics; Vaccines, DNA/pharmacokinetics*; Vaccines, DNA/chemistry*; Dendrimers/pharmacokinetics*; Dendrimers/chemistry*; tat Gene Products, Human Immunodeficiency Virus/pharmacokinetics; tat Gene Products, Human Immunodeficiency Virus/chemistry*
Structural and Ionic Transport Properties of Protonic Conducting Solid Biopolymer Electrolytes Based on Carboxymethyl Cellulose Doped with Ammonium Fluoride

Ramlli MA, Isa MI

J Phys Chem B, 2016 11 10;120(44):11567-11573.
PMID: 27723333

Fourier transform infrared (FT-IR), X-ray diffraction (XRD), and transference number measurement (TNM) techniques were applied to investigate the complexation, structural, and ionic transport properties of and the dominant charge-carrier species in a solid biopolymer electrolyte (SBE) system based on carboxymethyl cellulose (CMC) doped with ammonium fluoride (NH4F), which was prepared via a solution casting technique. The SBEs were partially opaque in appearance, with no phase separation. The presence of interactions between the host polymer (CMC) and the ionic dopant (NH4F) was proven by FT-IR analysis at the C-O band. XRD spectra analyzed using Origin 8 software disclose that the degree of crystallinity (χc%) of the SBEs decreased with the addition of NH4F, indicating an increase in the amorphous nature of the SBEs. Analysis of the ionic transport properties reveals that the ionic conductivity of the SBEs is dependent on the ionic mobility (μ) and diffusion of ions (D). TNM analysis confirms that the SBEs are proton conductors.

MeSH terms: Quaternary Ammonium Compounds/chemistry*; Biopolymers/chemistry*; Carboxymethylcellulose Sodium/chemistry*; Electric Conductivity; Electrolytes/chemistry; Fluorides/chemistry*; Protons*; Molecular Structure; Ion Transport
Zeolite Nanoparticles Inhibit Aβ-Fibrinogen Interaction and Formation of a Consequent Abnormal Structural Clot

Derakhshankhah H, Hajipour MJ, Barzegari E, Lotfabadi A, Ferdousi M, Saboury AA, et al.

ACS Appl Mater Interfaces, 2016 Nov 16;8(45):30768-30779.
PMID: 27766857

EMT-type zeolite nanoparticles (EMT NPs) with particle size of 10-20 nm and external surface area of 200 m2/g have shown high selective affinity toward plasma protein (fibrinogen). Besides, the EMT NPs have demonstrated no adverse effect on blood coagulation hemostasis. Therefore, it was envisioned that the EMT NPs could inhibit possible β-amyloid (Aβ)-fibrinogen interactions that result in the formation of structurally abnormal clots, which are resistant to lysis, in cerebral vessels of patients with Alzheimer disease (AD). To evaluate this hypothesis, the clot formation and degradation of Aβ-fibrinogen in the presence and absence of the EMT zeolite NPs were assessed. The results clearly showed that the delay in clot dissolution was significantly reduced in the presence of zeolite NPs. By formation of protein corona, the EMT NPs showed a negligible reduction in their inhibitory strength. Docking of small molecules (Aβ-fibrinogen) introduced a novel potential inhibitory candidate. The zeolite NPs showed similar inhibitory effects on binding of fibrinogen to both Aβ(25-35) and/or Aβ(1-42). This indicates that the inhibitory strength of these NPs is independent of Aβ sequence, and it is suggested that the zeolite NPs adsorb fibrinogen and specifically obstruct their Aβ binding sites. Therefore, the zeolite NPs can be the safe and effective inhibitors in preventing Aβ-fibrinogen interaction and consequent cognitive damage.
Fulltext Atheroprotective effects of pure tocotrienol supplementation in the treatment of rabbits with experimentally induced early and established atherosclerosis

Rahman TA, Hassim NF, Zulkafli N, Muid S, Kornain NK, Nawawi H

Food Nutr Res, 2016;60:31525.
PMID: 27799085 DOI: 10.3402/fnr.v60.31525

Atherosclerosis is the main cause of coronary artery disease -related deaths worldwide. The atheroprotective properties of pure tocotrienols (T3) in the absence of alpha-tocopherol (α-TCP) in vitamin E has not been extensively examined.
Predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge

Johari N, Manaf ZA, Ibrahim N, Shahar S, Mustafa N

Clin Interv Aging, 2016;11:1455-1461.
PMID: 27799751

PURPOSE: Diabetes mellitus is prevalent among older adults, and affects their quality of life. Furthermore, the number is growing as the elderly population increases. Thus, this study aims to explore the predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge in Malaysia.
METHODS: A total of 110 hospitalized geriatric patients aged 60 years and older were selected using convenience sampling method in a cross-sectional study. Sociodemographic data and medical history were obtained from the medical records. Questionnaires were used during the in-person semistructured interviews, which were conducted in the wards. Linear regression analyses were used to determine the predictors of each domain of quality of life.
RESULTS: Multiple regression analysis showed that activities of daily living, depression, and appetite were the determinants of physical health domain of quality of life (R(2)=0.633, F(3, 67)=38.462; P<0.001), whereas depression and instrumental activities of daily living contributed to 55.8% of the variability in psychological domain (R(2)=0.558, F(2, 68)=42.953; P<0.001). Social support and cognitive status were the determinants of social relationship (R(2)=0.539, F(2, 68)=39.763; P<0.001) and also for the environmental domain of the quality of life (R(2)=0.496, F(2, 68)=33.403; P<0.001).
CONCLUSION: The findings indicated different predictors for each domain in the quality of life among hospitalized geriatric patients with diabetes mellitus. Nutritional, functional, and psychological aspects should be incorporated into rehabilitation support programs prior to discharge in order to improve patients' quality of life.

MeSH terms: Activities of Daily Living; Aged; Cognition*; Cross-Sectional Studies; Depression/psychology*; Diabetes Mellitus/epidemiology; Diabetes Mellitus/psychology*; Female; Hospitalization; Humans; Malaysia/epidemiology; Male; Middle Aged; Quality of Life/psychology*; Surveys and Questionnaires; Social Support*; Geriatric Assessment/methods; Linear Models
Mutations, associated with early-onset Alzheimer's disease, discovered in Asian countries

Bagyinszky E, Youn YC, An SS, Kim S

Clin Interv Aging, 2016;11:1467-1488.
PMID: 27799753

Alzheimer's disease (AD), the most common form of senile dementia, is a genetically complex disorder. In most Asian countries, the population and the number of AD patients are growing rapidly, and the genetics of AD has been extensively studied, except in Japan. However, recent studies have been started to investigate the genes and mutations associated with AD in Korea, the People's Republic of China, and Malaysia. This review describes all of the known mutations in three early-onset AD (EOAD) causative genes (APP, PSEN1, and PSEN2) that were discovered in Asian countries. Most of the EOAD-associated mutations have been detected in PSEN1, and several novel PSEN1 mutations were recently identified in patients from various parts of the world, including Asia. Until 2014, no PSEN2 mutations were found in Asian patients; however, emerging studies from Korea and the People's Republic of China discovered probably pathogenic PSEN2 mutations. Since several novel mutations were discovered in these three genes, we also discuss the predictions on their pathogenic nature. This review briefly summarizes genome-wide association studies of late-onset AD and the genes that might be associated with AD in Asian countries. Standard sequencing is a widely used method, but it has limitations in terms of time, cost, and efficacy. Next-generation sequencing strategies could facilitate genetic analysis and association studies. Genetic testing is important for the accurate diagnosis and for understanding disease-associated pathways and might also improve disease therapy and prevention.

MeSH terms: Alzheimer Disease/genetics*; Alzheimer Disease/epidemiology; Asia/epidemiology; Genetic Testing; Humans; Mutation; Amyloid beta-Protein Precursor/genetics*; Asian Continental Ancestry Group/genetics*; Presenilin-1/genetics*; Presenilin-2/genetics*; Genome-Wide Association Study
Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place

Abdul Rani R, Raja Ali RA, Lee YY

Intest Res, 2016 Oct;14(4):297-304.
PMID: 27799880

Irritable bowel syndrome (IBS), a common gastrointestinal disorder involving the gut-brain axis, and inflammatory bowel disease (IBD), a chronic relapsing inflammatory disorder, are both increasing in incidence and prevalence in Asia. Both have significant overlap in terms of symptoms, pathophysiology, and treatment, suggesting the possibility of IBS and IBD being a single disease entity albeit at opposite ends of the spectrum. We examined the similarities and differences in IBS and IBD, and offer new thoughts and approaches to the disease paradigm.

MeSH terms: Gastrointestinal Microbiome; Asia; Brain; Chronic Disease; Gastrointestinal Diseases; Recurrence; Inflammatory Bowel Diseases; Incidence; Prevalence; Irritable Bowel Syndrome
Attenuation of Thrombosis by Crude Rice (Oryza sativa) Bran Policosanol Extract: Ex Vivo Platelet Aggregation and Serum Levels of Arachidonic Acid Metabolites

Wong WT, Ismail M, Tohit ER, Abdullah R, Zhang YD

Evid Based Complement Alternat Med, 2016;2016:7343942.
PMID: 27800004

Background. Vascular occlusion or thrombosis was often attributed to uncontrolled platelet activation. Influence of sugarcane policosanol extract on platelet was reported but little was known of rice bran policosanol, particularly its mechanisms of actions on platelet activities. Objective. Antiplatelet mechanisms of rice bran policosanol extract (RBE) were studied using hyperlipidemic Sprague Dawley rats. Ex vivo platelet aggregation, platelet count (PC), bleeding time (BT), and coagulation time were assayed. Serum eicosanoids and other aggregation-related metabolites levels were quantified. Design. Rats were divided into 6 groups for comparisons (vehicle control Tween 20/H2O, high dose policosanol 500 mg/kg, middle dose policosanol 250 mg/kg, low dose policosanol 100 mg/kg, and positive control aspirin 30 mg/kg). Results. Low dose 100 mg/kg of RBE inhibited aggregation by 42.32 ± 4.31% and this was comparable with the effect of 30 mg/kg aspirin, 43.91 ± 5.27%. Results showed that there were no significant differences in PC, BT, and coagulation time among various groups after RBE treatment. Serum thromboxane A2 was attenuated while prostacyclin level increased upon RBE treatment. Conclusions. RBE reduced ex vivo ADP-induced platelet aggregation without giving adverse effects. No changes in full blood count suggested that rice bran policosanol did not disturb biological blood cell production and destruction yet it reduced aggregation through different mechanisms.

MeSH terms: Animals; Aspirin; Biological Products; Bleeding Time; Blood Platelets; Fatty Alcohols; Platelet Aggregation; Platelet Count; Polysorbates; Epoprostenol; Oryza; Thromboxane A2; Platelet Activation; Rats, Sprague-Dawley; Saccharum; Rats
The Role of Isocitrate Lyase (ICL1) in the Metabolic Adaptation of Candida albicans Biofilms

Ishola OA, Ting SY, Tabana YM, Ahmed MA, Yunus MA, Mohamed R, et al.

Jundishapur J Microbiol, 2016 Sep;9(9):e38031.
PMID: 27800147

A major characteristic of Candida biofilm cells that differentiates them from free-floating cells is their high tolerance to antifungal drugs. This high resistance is attributed to particular biofilm properties, including the accumulation of extrapolymeric substances, morphogenetic switching, and metabolic flexibility.
Successful Resolution of Preretinal Haemorrhage with Intravitreal Ranibizumab

Noorlaila B, Zunaina E, Raja-Azmi MN

Case Rep Ophthalmol Med, 2016;2016:4164198.
PMID: 27800200

We would like to report two cases of preretinal haemorrhage from two different aetiology courses of bleeding being treated with intravitreal ranibizumab and its outcome. Our first case was a 39-year-old man with a diagnosis of severe aplastic anaemia that presented with bilateral premacular haemorrhages in both eyes. His right eye vision was 6/45 and it was counting finger in the left eye. He was treated with intravitreal ranibizumab once to the right eye and twice to the left eye. Right eye showed complete resolution of premacular haemorrhage and minimal residual premacular haemorrhage in the left eye at 3 months after initial presentation. Our second case was a 32-year-old healthy teacher that presented with preretinal haemorrhage at superotemporal region extending to macular area in left eye secondary to valsalva retinopathy. Her left vision was counting finger. She was treated with single intravitreal ranibizumab to the left eye. There was significant reduction of premacular haemorrhage and her left eye vision improved to 6/6 at 10 weeks after injection. Both cases had favourable outcome with intravitreal ranibizumab and can be considered as nonsurgical treatment option in treating premacular haemorrhage.

MeSH terms: Ranibizumab; Adult; Anemia, Aplastic; Eye; Female; Humans; Injections; Male; Retinal Diseases
Fulltext First Report of Eurycoma longifolia Jack Root Extract Causing Relaxation of Aortic Rings in Rats

Tee BH, Hoe SZ, Cheah SH, Lam SK

Biomed Res Int, 2016;2016:1361508.
PMID: 27800486 DOI: 10.1155/2016/1361508

Although Eurycoma longifolia has been studied for erectile function, the blood pressure- (BP-) lowering effect has yet to be verified. Hence, this study aims at investigating the BP-lowering properties of the plant with a view to develop an antihypertensive agent that could also preserve erectile function. Ethanolic root extract was partitioned by hexane, dichloromethane (DCM), ethyl acetate, butanol, and water. The DCM fraction, found to be potent in relaxing phenylephrine- (PE-) precontracted rat aortic rings, was further purified by column chromatography. Subfraction DCM-II, being the most active in relaxing aortae, was studied for effects on the renin-angiotensin and kallikrein-kinin systems in aortic rings. The effect of DCM-II on angiotensin-converting enzyme (ACE) activity was also evaluated in vitro. Results showed that DCM-II reduced (p < 0.05) the contractions evoked by angiotensin I and angiotensin II (Ang II). In PE-precontracted rings treated with DCM-II, the Ang II-induced contraction was attenuated (p < 0.05) while bradykinin- (BK-) induced relaxation enhanced (p < 0.001). In vitro, DCM-II inhibited (p < 0.001) the activity of ACE. These data demonstrate that the vasodilatory effect of DCM-II appears to be mediated via inhibition of Ang II type 1 receptor and ACE as well as enhancement of Ang II type 2 receptor activation and BK activity.

MeSH terms: Angiotensin I/metabolism; Angiotensin II/metabolism; Animals; Antihypertensive Agents/pharmacology; Aorta/drug effects*; Aorta/metabolism; Blood Pressure/drug effects; Bradykinin/metabolism; Male; Plant Extracts/pharmacology*; Renin-Angiotensin System/drug effects; Vasodilator Agents/pharmacology*; Kallikrein-Kinin System/drug effects; Rats, Sprague-Dawley; Plant Roots/chemistry*; Eurycoma/chemistry*; Rats
Fulltext Evaluation of PAIusp subtyping to characterize uropathogenic E. coli isolates

Lai YM, Zaw MT, Shamsudin SB, Lin Z

J Infect Dev Ctries, 2016 Oct 31;10(10):1053-1058.
PMID: 27801366 DOI: 10.3855/jidc.6944

INTRODUCTION: Uropathogenic virulence factors have been identified by comparing the prevalence of these among urinary tract isolates and environmental strains. The uropathogenic-specific protein (USP) gene is present on the pathogenicity island (PAI) of uropathogenic Escherichia coli (UPEC) and, depending on its two diverse gene types and the sequential patterns of three open reading frame units (orfUs) following it, there is a method to characterize UPEC epidemiologically called PAIusp subtyping.
METHODOLOGY: A total of 162 UPEC isolates from Sabah, Malaysia, were tested for the presence of the usp gene and the sequential patterns of three orfUs following it using polymerase chain reaction (PCR). In addition, by means of triplex PCR, the prevalence of the usp gene was compared with other two VFs of UPEC, namely alpha hemolysin (α-hly) and cytotoxic necrotizing factor (cnf-1) genes encoding two toxins.
RESULTS: The results showed that the usp gene was found in 78.40% of UPEC isolates, indicating that its prevalence was comparable to that found in a previous study in Japan. The two or three orfUs were also associated with the usp gene in this study. All the PAIusp subtypes observed in Japan were present in this study, while subtype IIa was the most common in both studies. The usp gene was observed in a higher percentage of isolates when compared with α-hly and cnf-1 genes.
CONCLUSIONS: The findings in Japan and Sabah, East Malaysia, were similar, indicating that PAIusp subtyping is applicable to the characterization of UPEC strains epidemiologically elsewhere in the world.

MeSH terms: Bacterial Toxins/genetics; Escherichia coli Infections/microbiology; Genotype*; Hemolysin Proteins/genetics; Humans; Japan; Malaysia; Urinary Tract Infections/microbiology; Polymerase Chain Reaction; Open Reading Frames; Molecular Epidemiology/methods; Gene Order; Escherichia coli Proteins/genetics*; Virulence Factors/genetics*; Genomic Islands; Uropathogenic Escherichia coli/classification*; Uropathogenic Escherichia coli/genetics*; Molecular Typing/methods*; Genotyping Techniques/methods
Fulltext A review of adult obesity research in Malaysia

Lim KG

Med J Malaysia, 2016 06;71(Suppl 1):1-19.
PMID: 27801384 MyJurnal

A literature search of articles as detailed in the paper Bibliography of clinical research in Malaysia: methods and brief results, using the MESH terms Obesity; Obesity, Abdominal; and Overweight; covering the years 2000 till 2015 was undertaken and 265 articles were identified. Serial population studies showed that the prevalence of obesity increased rapidly in Malaysia in the last decade of the twentieth century. This follows the rising availability of food per capita which had been begun two to three decades previously. Almost every birth cohort, even up to those in their seventh decade increased in prevalence of overweight and obesity between 1996 and 2006. However, the rise in prevalence in obesity appears to have plateaued after the first decade of the twentieth century. Women are more obese than men and Malays and Indians are more obese than Chinese. The Orang Asli (Aborigines) are the least obese ethnic group in Malaysia but that may change with socioeconomic development. Neither living in rural areas nor having low income protects against obesity. On the contrary, a tertiary education and an income over RM4,000/month is associated with less obesity. Malaysians are generally not physically active enough, in the modes of transportation they use and how they use their leisure time. Other criteria and measures of obesity have been investigated, such as the relevance of abdominal obesity, and the Asian criteria or Body Mass Index (BMI) cut-offs value of 23.0 kg/m2 for overweight and 27.0 kg/m2 for obesity, with the view that the risk of diabetes and other chronic diseases start to increase at lower values in Asians compared to Europeans. Nevertheless the standard World Health Organization (WHO) guidelines for obesity are still most widely used and hence is the best common reference. Guidelines for the management of obesity have been published and projects to combat obesity are being run. However, more effort needs to be invested. Studies on intervention programmes showed that weight loss is not easy to achieve nor maintain. Laboratory research worldwide has uncovered several genetic and biochemical markers associated with obesity. Similar studies in Malaysia have found some biomarkers with an association to obesity in the local population but none of great significance.

MeSH terms: Adult; Female; Humans; Malaysia; Malaysia/epidemiology; Male; Body Mass Index; Prevalence; Asian Continental Ancestry Group; Overweight
Fulltext A review of metabolic syndrome research in Malaysia

Lim KG, Cheah WK

Med J Malaysia, 2016 06;71(Suppl 1):20-28.
PMID: 27801385 MyJurnal

Seventy-three articles related to metabolic syndrome were found in a search through databases dedicated to indexing all literature with original data involving the Malaysian population between years 2000 and 2015. Metabolic syndrome affects 25 to 40% of adult population of Malaysia with the risk increasing with age. Obese children are also at risk. Indian ethnicity has the highest rates, followed by Malay and chinese. It was found that socioeconomics determinants such as living in urban areas, unemployment, lower income, lower education level and shift workers had higher prevalence of metabolic syndrome. Metabolic syndrome is associated with other medical conditions like cardiovascular diseases, psychiatric disorders, erectile dysfunction, polycystic ovarian syndrome and colorectal cancer. Several biomarkers have been determined to be relevant to our local population but their usage in clinical setting needs further research. Literature into effectiveness of management of metabolic syndrome in Malaysia is lacking and the results were only modest. there are several diagnostic criteria available for metabolic syndrome internationally and their individual significant to our local population is not clear. It also makes it difficult to compare results between studies using different criteria. Finally, we could not identify any local study to look at the health economic burden of metabolic syndrome locally.

MeSH terms: Ethnic Groups; Humans; Malaysia; Male; Obesity; Research/trends*; Risk Factors; Prevalence
Fulltext A review of smoking research In Malaysia

Wee LH, Chan CM, Yogarabindranath SN

Med J Malaysia, 2016 06;71(Suppl 1):29-41.
PMID: 27801386 MyJurnal

Two hundred and seventy one original published materials related to tobacco use were found in a search through a database dedicated to indexing all original data relevant to Medicine and Health in Malaysia from 1996 - 2015. A total of 147 papers were selected and reviewed on the basis of their relevance and implications for future research. Findings were summarised, categorised and presented according to epidemiology, behaviour, clinical features and management of smoking. Most studies are cross-sectional with small sample sizes. Studies on smoking initiation and prevalence showed mixed findings with many small scale studies within the sub-groups. The majority of the studies were related to factors that contribute to initiation in adolescents. Nonetheless, there are limited studies on intervention strategies to curb smoking among this group. There is a lack of clinical studies to analyse tobacco use and major health problems in Malaysia. In addition, studies on the best treatment modalities on the use of pharmacotherapy and behavioural counselling have also remained unexplored. Reasons why smokers do not seek clinic help to quit smoking need further exploration. A finding on the extent of effort carried out by healthcare providers in assisting smokers to make quit attempts is not known. Studies on economic and government initiatives on policies and tobacco use focus mainly on the effects of cigarette bans, increased cigarettes taxes and the influence of the tobacco industry. Recommendations are given for the government to increase efforts in implementing smoke-free legislation, early and tailored interventions. Clinical studies in this area are lacking, as are opportunities to research on ways to reduce smoking initiation age and the most effective quit smoking strategies.

MeSH terms: Humans; Malaysia/epidemiology; Smoking/epidemiology*; Smoking Cessation*
A Review of Coronary Artery Disease Research in Malaysia

Ang CS, Chan KM

Med J Malaysia, 2016 06;71(Suppl 1):42-57.
PMID: 27801387 MyJurnal

Coronary artery disease is the major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on coronary artery disease in Malaysia published between 2000-2015. 508 papers were identified of which 146 papers were selected and reviewed on the basis of their relevance. The epidemiology, etiology, risk factors, prevention, assessment, treatment, and outcomes of coronary artery disease in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.

MeSH terms: Coronary Artery Bypass; Humans; Malaysia; Research/trends; Risk Factors; Treatment Outcome; Evidence-Based Medicine
Fulltext A review of stroke research in Malaysia from 2000 - 2014

Cheah WK, Hor CP, Abdul Aziz Z, Looi I

Med J Malaysia, 2016 Jun;71(Suppl 1):58-69.
PMID: 27801388

Over 100 articles related to stroke were found in a search through a database dedicated to indexing all literature with original data involving the Malaysian population between years 2000 and 2014. Stroke is emerging as a major public health problem. The development of the National Stroke Registry in the year 2009 aims to coordinate and improve stroke care, as well as to generate more data on various aspects of stroke in the country. Studies on predictors of survival after strokes have shown potential to improve the overall management of stroke, both during acute event and long term care. Stroke units were shown to be effective locally in stroke outcomes and prevention of stroke-related complications. The limited data looking at direct cost of stroke management suggests that the health economic burden in stroke management may be even higher. Innovative rehabilitation programmes including braincomputer interface technology were studied with encouraging results. Studies in traditional complementary medicine for strokes such as acupuncture, Urut Melayu and herbal medicine were still limited.

MeSH terms: Humans; Malaysia; Research; Review; Stroke
A review of lung cancer research in Malaysia

Kan CS, Chan KM

Med J Malaysia, 2016 06;71(Suppl 1):70-78.
PMID: 27801389 MyJurnal

Lung cancer is a major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on lung cancer in Malaysia published between 2000-2015. 89 papers were identified, of which 64 papers were selected and reviewed on the basis of their relevance to the review. The epidemiology, risk factors, cell types, clinical presentation, diagnosis, treatment, outcomes, prevention, and the social impact of lung cancer in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.

MeSH terms: Humans; Malaysia; Research/trends*; Risk Factors
Fulltext A review of acute rheumatic fever and rheumatic heart disease research in Malaysia

Hung LC, Nadia R

Med J Malaysia, 2016 06;71(Suppl 1):79-86.
PMID: 27801390 MyJurnal

A total of 39 titles related to rheumatic fever or rheumatic heart disease in Malaysia were found with online literature search dating back to their inceptions and through 2014. Additional publications from conference journals were included. Nine papers were selected based on clinical relevance and future research implications. There were no population-based studies on the incidence or prevalence of ARF or RHD. In the 1980s, the incidence of admission due to ARF ranged from 2 to 21.1 per 100 000 paediatric admission per year. The burden of disease was significant in the adult population; 74.5% of patients with RHD were female, of which 77.1% were in the reproductive age group of 15-45 years old. Rheumatic mitral valve disease constituted almost half (46.7%) of all mitral valve repairs, ranging from 44.8 - 55.8 patients per year from 1997 - 2003. From 2010-2012, mitral valve interventions increased to 184 per year, of which 85.7% were mitral valve repair. In children with ARF, 25.4% - 41.7% had past history of rheumatic fever or RHD. In patients with rheumatic mitral valve disease undergoing surgical or medical interventions, only 6% reported history of ARF, none had history of GABHS pharyngitis or antibiotic prophylaxis. Only 44.7% of patients with RHD on follow-up were on intramuscular benzathine penicillin prophylaxis. Overall, there is scarcity of publications on ARF and RHD in Malaysia. Priority areas for research include determination of the incidence and prevalence of ARF and RHD, identification of high-risk populations, evaluation on the implementation and adherence of secondary preventive measures, identification of subclinical RHD especially amongst the high-risk population, and a surveillance system to monitor and evaluate preventive measures, disease progression and outcomes.

MeSH terms: Adolescent; Adult; Child; Female; Humans; Malaysia/epidemiology; Middle Aged; Risk Factors; Incidence; Young Adult

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