Browse publications by year: 2018

  1. Soe HHK, Than NN, Lwin H, Phyu KL, Htay MNN, Moe S, et al.
    J Family Med Prim Care, 2018 9 21;7(4):756-761.
    PMID: 30234049 DOI: 10.4103/jfmpc.jfmpc_300_17
    Background: Disease surveillance is one of the major components to combat against infectious diseases. As health-care professionals are indispensable to mandatory notifiable disease surveillance, their knowledge and attitudes toward infectious disease notification played an important role for timely and effective reporting to the surveillance system. Therefore, we aimed to determine the knowledge of mandatory notifiable infectious diseases in Malaysia and attitude towards infectious disease reporting among final year medical students.

    Methods: A cross-sectional study was conducted from May to June 2017 in the private medical college in Malaysia.

    Materials and Methods: We purposively selected the final year (semester 10) medical students and a total of 124 students participated in this study. We collected data using a self-administered, structured questionnaire. Data were analyzed using descriptive statistics, independent t-test, and one-way analysis of variance.

    Results: Among the final year medical students, 47.5% had moderate knowledge but 4.2% had good knowledge of mandatory infectious disease notification. Only 3.2% of the students correctly answered all the notifiable diseases listed in the questionnaire. Most of the students had positive attitude toward communicable diseases reporting, rewards, and penalty for notification. There was no significant relationship between sociodemographic characteristics and knowledge and attitude of infectious disease notification.

    Conclusions: The majority of the final year medical students had moderate level of knowledge and positive attitude of infectious disease notification; however, there were some deficiencies. Better instruction and training on infectious disease notification procedures of Malaysia should be provided to the final year medical students which could not only reduce underreporting but also improve timely and effective reporting in future.

    MeSH terms: Analysis of Variance; Attitude; Communicable Diseases; Cross-Sectional Studies; Health Personnel; Humans; Malaysia; Surveys and Questionnaires; Reward; Students, Medical; Disease Notification; Knowledge
  2. Jamshed SQ, Siddiqui MJ, Rana B, Bhagavathula AS
    Front Public Health, 2018;6:244.
    PMID: 30234088 DOI: 10.3389/fpubh.2018.00244
    Objectives: To analyze the studies encompassing the involvement of pharmacists in diabetes self-care.
    Method: We reviewed studies conducted from 2005 to 2017 on the involvement of pharmacists in diabetes self-care. The keywords mainly used in this search are pharmacoeconomic analysis, diabetes self-care, pharmacist involvement,cost-effectiveness analysis, cost of utilization, cost of illness, cost of minimization and cost-benefit analysis. PubMed, Science Direct, Springer Link and Medline searched for the relevant studies. These databases searched for full text articles ranging from 2007 to 2017. We tried to limit the search with the inclusion of studies having any sort of pharmacoeconomically relevant component.
    Key Findings: Cost of illness varied among the countries in managing diabetes mellitus, and the cost of managing diabetes complications were twice the cost of management of diabetes. Continuous involvement of the pharmacist in primary health care is a cost-effective strategy and pronounced to be essential for helping diabetes patient in controlling and managing their disease. Implementation of diabetes self-care by pharmacists such as lifestyle intervention rendered improved quality of life of patient without any increase in health care cost. Self-care management generates intensive blood glucose control and improved quality of life.
    Conclusions: Implementation of diabetic self-care intervention including intensive lifestyle intervention, education, self-monitoring of blood glucose and adherence toward medication-initiated reduction in the overall healthcare cost of diabetic patients compared to patients relying on only any one of the interventions. Impact of diabetes self-care intervention by pharmacist reported to significantly reduce the HbA1C levels of diabetic patients along with the reduction of yearly healthcare cost. This review showed that pharmacist involvement in diabetes self-care interventions prove to be cost-effective and can significantly affect the condition of the diabetic patients and reduces the risk of complications.
    MeSH terms: Blood Glucose; Cost-Benefit Analysis; Humans; Life Style; Pharmacists; Primary Health Care; Quality of Life; Self Care; MEDLINE; Health Care Costs; Cost of Illness; Economics, Pharmaceutical; PubMed; Diabetes Complications
  3. Wijesekara P, Ng WH, Feng M, Ren X
    Curr Opin Organ Transplant, 2018 12;23(6):657-663.
    PMID: 30234735 DOI: 10.1097/MOT.0000000000000577
    PURPOSE OF REVIEW: Engineering vasculature that meets an organ's specific physiology and function is a fundamental step in organ bioengineering. In this article, we review approaches for engineering functional vasculature for organ bioengineering, with an emphasis on the engineering of organ-specific endothelium and vasculature.

    RECENT FINDINGS: Recent advances in hydrogel-based engineering of vascularized organ bud enable vascular regeneration in self-assembled cellular niche containing parenchymal and stromal cells. The emerging technology of whole-organ decellularization provides scaffold materials that serve as extracellular niche guiding vascular regeneration to recapitulate native organ's vascular anatomy. Increasing morphological and molecular evidences suggest endothelial heterogeneity across different organs and across different vascular compartments within an organ. Deriving organ-specific endothelium from pluripotent stem cells has been shown to be possible by combining endothelial induction with parenchymal differentiation.

    SUMMARY: Engineering organ-specific vasculature requires the combination of organ-specific endothelium with its unique cellular and extracellular niches. Future investigations are required to further delineate the mechanisms for induction and maintenance of organ-specific vascular phenotypes, and how to incorporate these mechanisms to engineering organ-specific vasculature.

    MeSH terms: Animals; Humans; Tissue Engineering/standards*; Bioengineering/methods*
  4. Stahnisch FW, Hor JY
    J Hist Neurosci, 2018 09 20;27(4):375-389.
    PMID: 30235045 DOI: 10.1080/0964704X.2018.1514852
  5. Abdul Razak, H.R., Azmi, N.A., Vinjamuri, S.
    MyJurnal
    Positron emission tomography-computed tomography (PET-CT) is a hybrid imaging modality that plays a crucial role in detecting and managing oesophageal cancer. However, not much is known about the clinicians’ perspective on its usage for oesophageal cancer. The aim of this study is to know the perspective of clinicians on the utilisation of PET-CT imaging for oesophageal cancer patients. A total of 73 clinicians with multidisciplinary clinical specialties for oesophageal cancer management were interviewed. All these clinicians had completed a survey consisting of 31 questions on; practicality, clinical efficacy and cost-effectiveness of PET-CT. The survey used Likert-scale to evaluate the responses. In terms of PET-CT practicality and clinical efficacy 39.7% - 43.8% and 47.9% - 83.5% of the sample respectively responded positively while in with regards to cost effectiveness, there was a significant difference from being neutral to having no opinion in 6 out of 9 questions. It was clear from the study that PET-CT has positive impact in the management of oesophageal cancer patients. However, issues related to expertise, availability, staffing and bureaucracy need to be addressed to improve competency and quality of services.
  6. Md Saad, W.M., Mohd Nor, N.A., Abdul Razak, H.R., Mat Salleh, M.S., Abdul Rasid, A., Hanifah, R.
    MyJurnal
    Ionising radiation (IR) has been extensively used as therapy and diagnostic modality to detect abnormalities inside a human body. Interaction between IR and cells can lead to production of free radicals. This study aims to evaluate radioprotective properties of 50% watermelon juice against low dose ionising radiation (LDIR)-induced stress in mice lung and liver tissues following 14 days of juice supplementation. Eighteen (18) ICR mice were randomly divided into three groups, negative control (Cx), radiation (Rx) and treatment group (Tx). The Cx group was treated with normal diet and filtered water while the Rx group was given a normal diet, filtered water and irradiated with 100 µGy x-ray; Tx group was fed a normal diet, 50% watermelon juice and irradiated with 100 µGy x-ray. After 14 days, level of superoxide dismutase (SOD), reduced glutathione (GSH) and malondialdehyde (MDA) in lung and liver tissues were evaluated. The SOD inhibition activity revealed a significant decrease in Rx and Tx compared with Cx (p
  7. Nicky Rahmana Putra, Mohd Azizi Che Yunus, Muhammad Syafiq Hazwan Ruslan, Fadillah Nur Idrus, Zuhaili Idham
    MyJurnal
    The objective of this study was to compare the extraction of peanut skin using supercritical carbon dioxide extraction and soxhlet extraction in terms of oil yield and catechin. For supercritical fluid extraction, the temperatures used were 40 and 70°C, while pressure used was 10 and 30 MPa, the flow rate was CO2 3 mL/min, and the concentration of co-solvents was 0 and 5%. Meanwhile, for soxhlet extraction, the extraction time was 6 hr with ethanol, hexane and water as the solvents. The results showed that soxhlet extraction gave the highest yield of extract (36.282%) using ethanol as solvent as compared with supercritical CO2 extraction (15.47%) at pressure 30 MPa, temperature 70°C and 5% concentration of co-solvent. This study reveals that the extracts from SC-CO2 extraction yielded the highest amount of catechin (208.73 µg/g sample) compared with that yielded in the soxhlet extraction (42.24 73 µg/g sample) with distilled water as a solvent analysed with High Performance Liquid Chromatography (HPLC).
  8. Haliza Tugeman, Normastura Abd Rahman, Azizah Yusoff, Mohd Khairi Md Daud
    MyJurnal
    Many studies have indicated that hearing-impaired (HI) children have poor oral hygiene mainly
    contributed by difficulties in communication. The objectives of the study were to assess the difficulties
    experienced by HI children during dental visit and the effectiveness of “Oral Health Care for the HearingImpaired”
    (OCHI) programme in improving the oral health knowledge and practice, and reducing the dental
    plaque maturity scores among HI children. A community intervention study was conducted and training of trainers
    (TOT) was done to train the teachers in delivering oral health education (OHE) and practices by using developed
    booklet and video. The difficulties faced by the HI children during dental visit, and the oral health knowledge and
    practice (OHKP) were assessed by face-to-face interview with HI children whilst the dental plaque maturity was
    assessed using GC Tri Plaque ID Gel™ (TPID) during pre-intervention, post-intervention-1 and postintervention-2.
    Data were analysed using SPSS version 22. Among the teachers, there was an increase in the
    mean (SD) total knowledge and attitude score during post-TOT compared to pre-TOT, 46.1 (2.44) and 43.7
    (4.01); (p
  9. Nurul Hana Mokhtar, Khairuddin Abdullah, Fairuz Mohd Ibrahim, Irfan Mohamad
    MyJurnal
    Branchial apparatus anomalies usually manifest in teenage or early adult life. Infection complicates
    second branchial pouch anomalies usually presented as a neck lump or discharging sinus. It is the most common
    form of anomalies compared to another branchial pouch aberrant. However, it is extremely rare to find a
    complete branchial fistula with both internal and external openings. Misdiagnosis usually occurs leading to
    inappropriate and suboptimal treatment. Here, we report of a case of complete second branchial pouch fistula
    and discuss the clinical presentation and surgical management of such lesion.
    MeSH terms: Adolescent; Adult; Branchioma; Diagnostic Errors; Fistula; Head and Neck Neoplasms; Humans; Physical Therapy Modalities
  10. Ahmad Sahril Hussin, Nik Azrizie Muhamed, Haryati Husin, Irfan Mohamad
    MyJurnal
    Intramuscular haemangioma is relatively rare and accounts for less than 1% of all haemangioma.
    Most of these tumours occur in the trunk, arms and legs. Only 14% of all intramuscular haemangioma arise
    from the head and neck region, with masseter muscle representing the most common site of involvement,
    followed by the trapezius and sternocleidomastoid muscles. We present a case of a 60-year-old man with a
    soft lump in the left cheek. Imaging of the neck showed irregular, dilated enhancing vessels seen in the left
    masseter muscle suggestive of intramuscular haemangioma. Excisional biopsy was performed, and
    histopathological findings confirmed the diagnosis.
    MeSH terms: Biopsy; Cheek; Hemangioma; Humans; Male; Masseter Muscle; Middle Aged; Neck; Neck Muscles; Superficial Back Muscles
  11. Asfizahrasby Mohd Rasoul, Norliwati Ibrahim
    MyJurnal
    Tornwaldt (Thornwaldt) or nasopharyngeal cyst is a cyst occurred at the connection site of
    pharyngeal endoderm and notochord remnant, usually located in the midline postero-superior wall of
    nasopharynx. Nasopharynx’s obstruction, recurrent infection or trauma may exacerbate mucous secretion
    by the potential space lining. Although rare and is usually symptomless, it is not uncommon for the patients
    to have some nasal, ear, cervical or oral symptoms. We report a case of Tornwaldt cyst with rare
    associated dental symptoms. The patient’s initial presentations were dry mouth, cheek biting, post nasal
    drip and few nasal symptoms including frequent snoring, sleep apnoea, mouth breathing, sneezing, sore
    throat and itchiness. These symptoms were tremendously and immediately relieved once the cyst was
    surgically removed.
  12. Nor Farid Mohd Noor, Mohamad Ezany Yusoff, Suharni Mohamad, Ahmad Mukifza Harun, Shahril Yusof
    MyJurnal
    Staphylococcus aureus (S. aureus) is an important bacterium with significant pathological implications
    in the field of medicine. Attempting to cure bacterial infections at an advanced stage results in considerable waste
    of time, effort and expenditure. Thus, the prevention of such illnesses is paramount. Besides using chemical
    drugs to treat infections, several non-organic extracts have been tested in trials and been shown to impede the
    bacteria’s growth. This paper proposes that the modified hydrothermal nanotitania extract has great potential to
    combat this lethal organism. The viability of S. aureus was shown to be markedly reduced following the addition
    of nanotitania extract with 0.01%, 0.03% and 0.05% silver after 24, 48, and 72 hours. The ability of the
    nanotitania extract to inhibit the growth of S. aureus indicates its antimicrobial characteristics.
  13. Hamasha, Abed Al-Hadi, Almogbel, Lolowh, Alshehri, Abeer, Alssafia, Fatimah, Alghamdi, Hanan, Alajmia, Alanoud, et al.
    MyJurnal
    Upon reviewing the literature, the prevalence of many systemic conditions such as diabetes,
    hypertension, asthma and rheumatoid arthritis were reported to be high in Saudi Arabia. The relationship of these
    conditions with tooth loss among Saudi population was not investigated. Therefore, the aim of the present study
    is to explore the relationship between tooth loss and most common medical conditions among Saudi dental
    patient. The study participants were 250 patients who were randomly selected from the College of Dentistry
    database of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Riyadh, Saudi Arabia.
    Participants were requested to answer self-administered questionnaires related to their demographic as well as
    general health questions concerned to the presence of systemic medical conditions. Missing teeth were
    determined after examining the orthopantogram radiographs and reviewing the Romexis and SALUD databases.
    Descriptive statistics, independent t-test and linear multiple regression model were performed using SPSS
    software. The mean number of missing teeth among the study population was 5.8 teeth per person. The mean
    number of missing teeth was higher among subjects with diabetes, hypertension, rheumatoid arthritis,
    cardiovascular diseases, or osteoporosis compared to healthy individuals. A multiple linear regression analysis
    model revealed that diabetes, hypertension and rheumatoid were significant predictors of missing teeth among
    Saudi population. These results highlight the importance of the effect of medical conditions on oral health.
    MeSH terms: Arthritis, Rheumatoid; Asthma; Diabetes Mellitus; Humans; Hypertension; Oral Health; Osteoporosis; Surveys and Questionnaires; Radiography, Panoramic; Saudi Arabia; Software; Universities; Prevalence; Linear Models; Tooth Loss
  14. Mohd Nor NA, Abdul Razak I, Ab-Murat N, Ismail N, Ibrahim F
    MyJurnal
    Tobacco usage among dental students and the amount of training they received may have an impact on tobacco cessation activities undertaken for their patients. This study aims to assess Malaysian dental students’ tobacco use, exposure to second-hand smoke and their attitude towards tobacco control activities and curriculum. This was a cross-sectional study using a self-administered questionnaire adapted from the Global Health Professions Students Survey (GHPSS). The questionnaire was distributed to all Malaysian fourth and fifth year
    dental students in four public dental schools (n=372), namely University of Malaya (UM), Universiti Teknologi Mara (UiTM), Universiti Kebangsaan Malaysia (UKM) and Universiti Sains Islam Malaysia (USIM). The data were analysed using descriptive and chi square tests. In total, (n=349) respondents completed the questionnaire, yielding a 93.8% response rate. Although the prevalence of Malaysian dental students who ‘ever smoked’ was 21.2%, the prevalence of current smokers was low (2.3%). About 62% and 39% of students reported having been exposed to second-hand smoke in public and at home, respectively. USIM students were significantly less likely to recall having received training about approaches to smoking cessation (52.9%, p<0.001). Significantly fewer smokers than nonsmokers agreed on tobacco banning policy. Regardless of their smoking status, the majority of dental students showed positive attitudes towards dentists’ role in tobacco cessation. Tobacco user among Malaysian dental students was low. There were statistically significant differences between ever smokers and non-smokers’ attitudes towards tobacco banning policy. The majority of dental students showed positive attitudes towards dentists’ role in
    tobacco cessation.
    Keywords: Attitudes; GHPSS; public health; smoking; tobacco
    MeSH terms: Cross-Sectional Studies; Humans; Health Knowledge, Attitudes, Practice*; Malaysia; Smoking*; Students, Dental; Universities; Young Adult
  15. Foth M, Ismail NFB, Kung JSC, Tomlinson D, Knowles MA, Eriksson P, et al.
    J Pathol, 2018 Nov;246(3):331-343.
    PMID: 30043421 DOI: 10.1002/path.5143
    Recent studies of muscle-invasive bladder cancer show that FGFR3 mutations are generally found in a luminal papillary tumour subtype that is characterised by better survival than other molecular subtypes. To better understand the role of FGFR3 in invasive bladder cancer, we examined the process of tumour development induced by the tobacco carcinogen OH-BBN in genetically engineered models that express mutationally activated FGFR3 S249C or FGFR3 K644E in the urothelium. Both occurrence and progression of OH-BBN-driven tumours were increased in the presence of an S249C mutation compared to wild-type control mice. Interestingly, at an early tumour initiation stage, the acute inflammatory response in OH-BBN-treated bladders was suppressed in the presence of an S249C mutation. However, at later stages of tumour progression, increased inflammation was observed in S249C tumours, long after the carcinogen administration had ceased. Early-phase neutrophil depletion using an anti-Ly6G monoclonal antibody resulted in an increased neutrophil-to-lymphocyte ratio at later stages of pathogenesis, indicative of enhanced tumour pathogenesis, which supports the hypothesis that suppression of acute inflammation could play a causative role. Statistical analyses of correlation showed that while initial bladder phenotypes in morphology and inflammation were FGFR3-dependent, increased levels of inflammation were associated with tumour progression at the later stage. This study provides a novel insight into the tumour-promoting effect of FGFR3 mutations via regulation of inflammation at the pre-tumour stage in the bladder. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
    MeSH terms: Animals; Urinary Bladder Neoplasms; Carcinogens; Copyright; Inflammation; Ireland; Lymphocytes; Mutation; Neutrophils; Nuclear Family; Phenotype; Tobacco; Urothelium; Mice; Receptor, Fibroblast Growth Factor, Type 3
  16. Xu LL, Zhang HF, Li M, Ng SW, Feng JH, Mao JG, et al.
    J Am Chem Soc, 2018 09 19;140(37):11569-11572.
    PMID: 30141923 DOI: 10.1021/jacs.8b06725
    Chiroptical activity is observed from an achiral adenine-containing metal-organic framework (MOF) named ZnFDCA. Such a seemingly counterintuitive phenomenon can, in fact, be predicted by the intrinsic crystal symmetry of 4̅2 m point group. Although theoretically allowed, examples of optically active achiral crystals are extremely rare. ZnFDCA is the first reported achiral MOF showing optical activity, as demonstrated by a pair of circular dichroism signals with opposite signs and enhanced intensity. Moreover, simply through adding an amino substituent to adenine, the chiroptical activity, as well as nonlinear optical activity, of the analogous MOF, namely ZnFDCA-NH2, disappears due to diverse packing pattern giving rise to centrosymmetric crystal symmetry.
    MeSH terms: Adenine/chemistry*; Particle Size; Optics and Photonics
  17. Idros N, Chu D
    ACS Sens, 2018 09 28;3(9):1756-1764.
    PMID: 30193067 DOI: 10.1021/acssensors.8b00490
    Heavy metals are highly toxic at trace levels and their pollution has shown great threat to the environment and public health worldwide where current detection methods require expensive instrumentation and laborious operation, which can only be accomplished in centralized laboratories. Herein, we report a low-cost, paper-based microfluidic analytical device (μPAD) for facile, portable, and disposable monitoring of mercury, lead, chromium, nickel, copper, and iron ions. Triple indicators or ligands that contain ions or molecules are preloaded on the μPADs and upon addition of a metal ion, the colorimetric indicators will elicit color changes observed by the naked eyes. The color features were quantitatively analyzed in a three-dimensional space of red, green, and blue or the RGB-space using digital imaging and color calibration techniques. The sensing platform offers higher accuracy for cross references, and is capable of simultaneous detection and discrimination of different metal ions in even real water samples. It demonstrates great potential for semiquantitative and even qualitative analysis with a sensitivity below the safe limit concentrations, and a controlled error range.
    MeSH terms: Calibration; Color; Colorimetry/instrumentation; Colorimetry/methods*; Indicators and Reagents/chemistry; Paper; Water Pollutants, Chemical/analysis*; Metals, Heavy/analysis*; Microfluidic Analytical Techniques/instrumentation; Microfluidic Analytical Techniques/methods; Lab-On-A-Chip Devices; Drinking Water/analysis; Ponds/analysis; Waste Water/analysis
  18. Tan SMQ, Chiew Y, Ahmad B, Kadir KA
    Nutrients, 2018 Sep 17;10(9).
    PMID: 30227659 DOI: 10.3390/nu10091315
    Tocotrienol-rich vitamin E from palm oil (Tocovid) has been shown to ameliorate diabetes through its superior antioxidant, antihyperglycemic, and anti-inflammatory properties in diabetic rats. This study aimed to investigate the effects of Tocovid on diabetic nephropathy in patients with type 2 diabetes. Baseline parameters of potential subjects such as HbA1c, blood pressure, Advanced Glycation Endproduct (AGE), soluble receptor for AGE (sRAGE), Nε-Carboxymethyllysine (Nε-CML), and Cystatin C were assessed for possible correlation with diabetic nephropathy. Only subjects with diabetic nephropathy or urine microalbuminuria-positive defined as Urine Albumin to Creatinine Ratio (UACR) >10 mg/mmol were recruited into a prospective, randomized, double-blinded, placebo-controlled trial. The intervention group (n = 22) received Tocovid 200 mg twice a day while the control group (n = 23) received placebo twice a day for 8 weeks. Changes in Hemoglobin A1c (HbA1c), blood pressure, serum biomarkers and renal parameters such as UACR, serum creatinine, and estimated Glomerular Filtration Rate (eGFR) were compared between the two groups. It was found that serum Nε-CML significantly correlated to the severity of microalbuminuria. For every 1 ng/mL increase in serum Nε-CML, the odds of diabetic nephropathy increased by 1.476 times. Tocovid, compared to placebo, significantly reduced serum creatinine but not eGFR, UACR, HbA1c, blood pressure, and serum biomarkers. In conclusion, serum Nε-CML is a potential biomarker for diabetic nephropathy. Treatment with Tocovid significantly reduced serum creatinine; therefore Tocovid may be a useful addition to the current treatment for diabetic nephropathy.
    MeSH terms: Aged; Albuminuria/blood; Albuminuria/drug therapy; Albuminuria/etiology; Albuminuria/physiopathology; Creatinine/blood; Diabetes Mellitus, Type 2/blood; Diabetes Mellitus, Type 2/complications; Diabetes Mellitus, Type 2/drug therapy*; Diabetes Mellitus, Type 2/physiopathology; Diabetic Nephropathies/blood; Diabetic Nephropathies/drug therapy*; Diabetic Nephropathies/etiology; Diabetic Nephropathies/physiopathology; Double-Blind Method; Female; Glomerular Filtration Rate/drug effects; Humans; Kidney/drug effects*; Kidney/physiopathology; Lysine/analogs & derivatives; Lysine/blood; Malaysia; Male; Middle Aged; Pilot Projects; Prospective Studies; Time Factors; Biomarkers/blood; Treatment Outcome; Tocotrienols/adverse effects; Tocotrienols/therapeutic use*
  19. Abubakar M, Sung H, Bcr D, Guida J, Tang TS, Pfeiffer RM, et al.
    Breast Cancer Res, 2018 09 18;20(1):114.
    PMID: 30227867 DOI: 10.1186/s13058-018-1033-8
    BACKGROUND: Limited evidence, mostly from studies in Western populations, suggests that the prognostic effects of lifestyle-related risk factors may be molecular subtype-dependent. Here, we examined whether pre-diagnostic lifestyle-related risk factors for breast cancer are associated with clinical outcomes by molecular subtype among patients from an understudied Asian population.

    METHODS: In this population-based case series, we evaluated breast cancer risk factors in relation to 10-year all-cause mortality (ACM) and 5-year recurrence by molecular subtype among 3012 women with invasive breast cancer in Sarawak, Malaysia. A total of 579 deaths and 314 recurrence events occurred during a median follow-up period of ~ 24 months. Subtypes (luminal A-like, luminal B-like, HER2-enriched, triple-negative) were defined using immunohistochemical markers for hormone receptors and human epidermal growth factor receptor 2 (HER2) in conjunction with histologic grade. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between risk factors and ACM/recurrence were estimated in subtype-specific Cox regression models.

    RESULTS: We observed heterogeneity in the relationships between parity/breastfeeding, age at first full-term pregnancy (FFP), family history, body mass index (BMI), and tumor subtype (p value  30 vs 

    MeSH terms: Adult; Aged; Aged, 80 and over; Breast Neoplasms/ethnology*; Breast Neoplasms/metabolism; Breast Neoplasms/epidemiology; China/ethnology; Female; Humans; Malaysia/epidemiology; Middle Aged; Neoplasm Recurrence, Local; Receptors, Estrogen/metabolism; Receptors, Progesterone/metabolism; Risk Factors; Receptor, ErbB-2/metabolism; Asian Continental Ancestry Group/statistics & numerical data*; Kaplan-Meier Estimate; Young Adult
  20. Apisarnthanarak A, Kwa AL, Chiu CH, Kumar S, Thu LTA, Tan BH, et al.
    Infect Control Hosp Epidemiol, 2018 10;39(10):1237-1245.
    PMID: 30227898 DOI: 10.1017/ice.2018.188
    Inappropriate use of antibiotics is contributing to a serious antimicrobial resistance problem in Asian hospitals. Despite resource constraints in the region, all Asian hospitals should implement antimicrobial stewardship (AMS) programs to optimize antibiotic treatment, improve patient outcomes, and minimize antimicrobial resistance. This document describes a consensus statement from a panel of regional experts to help multidisciplinary AMS teams design programs that suit the needs and resources of their hospitals. In general, AMS teams must decide on appropriate interventions (eg, prospective audit and/or formulary restriction) for their hospital, focusing on the most misused antibiotics and problematic multidrug-resistant organisms. This focus is likely to include carbapenem use with the goal to reduce carbapenem-resistant gram-negative bacteria. Rather than initially trying to introduce a comprehensive, hospital-wide AMS program, it would be practical to begin by pilot testing a simple program based on 1 achievable core intervention for the hospital. AMS team members must work together to determine the most suitable AMS interventions to implement in their hospitals and how best to put them into practice. Continuous monitoring and feedback of outcomes to the AMS teams, hospital administration, and prescribers will enhance sustainability of the AMS programs.
    MeSH terms: Anti-Bacterial Agents; Goals; Gram-Negative Bacteria; Hospital Administration; Hospitals; Humans; Prospective Studies; Carbapenems; Enterococcus; Drug Resistance, Bacterial; Consensus
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