Browse publications by year: 2018

  1. Mohamad Yusoff MA, Abdul Hamid AA, Mohammad Bunori N, Abd Halim KB
    J Mol Graph Model, 2018 Jun;82:137-144.
    PMID: 29730487 DOI: 10.1016/j.jmgm.2018.04.010
    Ebola virus is a lipid-enveloped filamentous virus that affects human and non-human primates and consists of several types of protein: nucleoprotein, VP30, VP35, L protein, VP40, VP24, and transmembrane glycoprotein. Among the Ebola virus proteins, its matrix protein VP40 is abundantly expressed during infection and plays a number of critical roles in oligomerization, budding and egress from the host cell. VP40 exists predominantly as a monomer at the inner leaflet of the plasma membrane, and has been suggested to interact with negatively charged lipids such as phosphatidylinositol 4,5-bisphosphate (PIP2) and phosphatidylserine (PS) via its cationic patch. The hydrophobic loop at the C-terminal domain has also been shown to be important in the interaction between the VP40 and the membrane. However, details of the molecular mechanisms underpinning their interactions are not fully understood. This study aimed at investigating the effects of mutation in the cationic patch and hydrophobic loop on the interaction between the VP40 monomer and the plasma membrane using coarse-grained molecular dynamics simulation (CGMD). Our simulations revealed that the interaction between VP40 and the plasma membrane is mediated by the cationic patch residues. This led to the clustering of PIP2 around the protein in the inner leaflet as a result of interactions between some cationic residues including R52, K127, K221, K224, K225, K256, K270, K274, K275 and K279 and PIP2 lipids via electrostatic interactions. Mutation of the cationic patch or hydrophobic loop amino acids caused the protein to bind at the inner leaflet of the plasma membrane in a different orientation, where no significant clustering of PIP2 was observed around the mutated protein. This study provides basic understanding of the interaction of the VP40 monomer and its mutants with the plasma membrane.
    MeSH terms: Amino Acids; Animals; Cell Membrane; Humans; Membranes; Mutation; Nucleoproteins; Phosphatidylinositols; Phosphatidylserines; Primates; Hemorrhagic Fever, Ebola; Ebolavirus; Static Electricity; Molecular Dynamics Simulation; Hydrophobic and Hydrophilic Interactions
  2. Ahmad W, Jantan I, Kumolosasi E, Haque MA, Bukhari SNA
    Int Immunopharmacol, 2018 Jul;60:141-151.
    PMID: 29730557 DOI: 10.1016/j.intimp.2018.04.046
    The in vivo immunomodulatory activities of Tinospora crispa have been reported but its molecular mechanisms underlying its immunomodulatory properties remains obscure and the active constituents contributing to the activities have not been identified. The present study was aimed to investigate the immunomodulatory effects of T. crispa extract (TCE) and its chemical constituents on RAW 264.7 macrophages. Six known compounds including magnoflorine and syringin were isolated by various chromatographic techniques from TCE and their structures were determined spectroscopically. A validated HPLC method was used to quantify magnoflorine and syringin in the extract. The immunomodulatory effects of TCE and its isolated compounds on chemotaxis, phagocytosis, production of inflammatory mediators including reactive oxygen species (ROS), nitric oxide (NO), prostaglandin E2 (PGE2) and pro-inflammatory cytokines which include tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and monocyte chemoattractant protein-1 (MCP-1) on macrophages were assessed. TCE increased the chemotaxis and phagocytic activity of macrophages and significantly enhanced the production of ROS, NO and pro-inflammatory cytokines. All alkaloids isolated, specifically magnoflorine showed remarkable inducing effects on the chemotaxis, phagocytic activity, ROS and NO productions and the secretions of IL-1β, TNF-α, IL6, PGE2 and MCP-1. In contrast, syringin potently reduced the chemotaxis, phagocytic activity, ROS and NO productions and secretions of IL-1β, TNF-α, IL6, PGE2 and MCP-1. TCE showed strong immunostimulant effects on various components of the immune system and these activities were possibly contributed mainly by the alkaloids specifically magnoflorine. TCE has potential to be developed as an effective natural immunostimulant for improvement of immune-related disorders.
    MeSH terms: Adjuvants, Immunologic; Aporphines; Chemotaxis; Chromatography, High Pressure Liquid; Macrophages; Nitric Oxide; Phagocytosis; Plant Extracts; Bodily Secretions; Tumor Necrosis Factor-alpha; Dinoprostone; Interleukin-6; Cytokines; Reactive Oxygen Species; Chemokine CCL2; Tinospora
  3. Guraya SY, Khoshhal KI, Yusoff MSB, Khan MA
    Med Teach, 2018 09;40(sup1):S83-S89.
    PMID: 29730951 DOI: 10.1080/0142159X.2018.1465532
    OBJECTIVES: Research has shown a fall of research productivity of faculty after their promotion to professor rank. This study explores the factors that lead to this decline in research productivity of professors in medical discipline.

    METHODS: A 20-item questionnaire was distributed online to medical professors of a Saudi, Malaysian and a Pakistani medical school. The participants were instructed to select their responses on a 5-point Likert's scale and the collected data was analyzed for quantitative and qualitative results.

    RESULTS: Of 161, 110 responded; response rate of 68.3%. About 35% professors spent 1-4 hours and 2% spent 19-25 hours per week for research. As many as 7% did not publish a single article and 29% had published 10 or more articles after attaining professor rank. During the last two years, 44% professors had published 5 or more research articles. Majority pointed out a lack of research support and funds, administrative burden and difficulty in data collection as the main obstacles to their research.

    CONCLUSIONS: This research has identified time constraints and insufficient support for research as key barriers to medical professors' research productivity. Financial and technical support and lesser administrative work load are some suggested remedies to foster the professors' research output.

    MeSH terms: Authorship; Career Mobility*; Faculty, Medical/statistics & numerical data*; Humans; Malaysia; Pakistan; Periodicals as Topic/statistics & numerical data; Publications/statistics & numerical data*; Saudi Arabia; Schools, Medical; Biomedical Research/statistics & numerical data*
  4. Lim D, Ma BC, Parumo R, Shanmuhasuntharam P
    Int J Oral Maxillofac Surg, 2018 Sep;47(9):1161-1165.
    PMID: 29731193 DOI: 10.1016/j.ijom.2018.04.015
    Submental intubation has been used as an alternative to conventional intubation in the field of oral and maxillofacial surgery since its introduction by Francisco Hernández Altemir in 1986. A review of submental intubation was performed using data from all case reports, case-series, and prospective and retrospective studies published between 1986 and 2016. The indications, variations in incision length, incision sites, types of endotracheal tube used, methods of exteriorization, and complications were recorded and analyzed. A total of 70 articles reporting 1021 patients were included. The main indication was maxillofacial trauma (86.9%, n=887), followed by orthognathic surgery (5.8%, n=59), skull base surgery (2.8%, n=29), and rhinoplasty and rhytidectomy (1.5%, n=15). The complication rate was relatively low: 91.0% of patients (n=929) were complication-free. The most common complication was infection, occurring in 3.5% (n=36) of the total number of patients, followed by scarring (1.2%, n=12) and formation of an orocutaneous or salivary fistula (1.1%, n=11). In summary, submental intubation is a good alternative airway with minimal complications.
    MeSH terms: Humans; Intubation, Intratracheal/adverse effects; Intubation, Intratracheal/methods*; Oral Surgical Procedures*
  5. Ramzan MS, Abbasi MA, Rehman A, Siddiqui SZ, Shah SAA, Ashraf M, et al.
    Pak J Pharm Sci, 2018 May;31(3(Supplementary)):1051-1059.
    PMID: 29731443
    An electrophile, N-(1,3-thiazol-2-yl)-2-bromoacetamide (3), was synthesized by the reaction of 1,3-thiazole-2-amine (1) and 2-bromoethanoyl bromide (2) in an aqueous medium. A series of carboxylic acids, 7a-j, were converted into 1,3,4-oxadiazole heterocyclic core, through a series of three steps. The final compounds, 8a-j, were synthesized by stirring 7a-j and 3 in an aprotic polar solvent. The structural elucidation of the synthesized compounds was supported by IR, EI-MS, 1H-NMR, and 13C-NMR spectral data. Title compounds were evaluated for enzyme inhibition against cholinesterases and α-glucosidase enzymes and their cytotoxic behavior was monitored using brine shrimp assay. The enzyme inhibitor potential of compounds was supported by molecular docking studies.
  6. Zain MA, Rouhollahi E, Pandy V, Mani V, Majeed ABA, Wong WF, et al.
    Exp Anim, 2018 Nov 01;67(4):421-429.
    PMID: 29731492 DOI: 10.1538/expanim.18-0006
    Phencyclidine (PCP) has been used to model cognitive deficits related to schizophrenia in rats and mice. However, the model in mice is not consistent in terms of the PCP effective dose reported. Furthermore, most of the previous studies in mice excluded the presence of drug washout period in the regime. Thus, we aimed to optimize the dose of PCP in producing robust cognitive deficits by implementing it in a PCP regime which incorporates a drug washout period. The regimen used was 7 days' daily injection of PCP or saline for treatment and vehicle groups, respectively; followed by 24 h drug washout period. After the washout period, the test mice were tested in water maze (5 days of acquisition + 1 day of probe trial) for assessment of spatial learning and memory. Initially, we investigated the effect of PCP at 2mg/kg, however, no apparent impairment in spatial learning and memory was observed. Subsequently, we examined the effect of higher doses of PCP at 5, 10 and 20 mg/kg. We found that the PCP at 10 mg/kg produced a significant increase in "latency to reach the platform" during the acquisition days and a significant increase in "latency of first entry to previous platform" during the probe day. There was no significant change observed in "swim speed" during the test days. Thus, we concluded that PCP at 10 mg/kg produced robust deficits in spatial learning and memory without being confounded by motor disturbances.
    MeSH terms: Animals; Disease Models, Animal; Dose-Response Relationship, Drug; Male; Memory Disorders/chemically induced*; Memory Disorders/psychology*; Mice, Inbred C57BL; Phencyclidine/administration & dosage; Phencyclidine/adverse effects*; Schizophrenic Psychology*; Excitatory Amino Acid Antagonists/administration & dosage; Excitatory Amino Acid Antagonists/adverse effects*; Spatial Memory/drug effects*; Spatial Learning/drug effects*
  7. Ng YK, Shah NM, Loong LS, Pee LT, Hidzir SAM, Chong WW
    Patient Prefer Adherence, 2018;12:615-624.
    PMID: 29731609 DOI: 10.2147/PPA.S159113
    Purpose: This study investigated patients' and pharmacists' attitudes toward concordance in a pharmacist-patient consultation and how patients' attitudes toward concordance relate to their involvement and self-efficacy in decision making associated with medication use.

    Subjects and methods: A cross-sectional study was conducted among patients with chronic diseases and pharmacists from three public hospitals in Malaysia. The Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to measure attitudes toward concordance in both patients and pharmacists. Patients also rated their perceived level of involvement in decision making and completed the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and independent t-test were used to determine significant differences between different subgroups on attitudes toward concordance, and multiple linear regression was performed to find the predictors of patients' self-efficacy in decision making.

    Results: A total of 389 patients and 93 pharmacists participated in the study. Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the RUS-LATCon scale, respectively. Seven items were found to be significantly different between pharmacists and patients on the subscale level. Patients who felt fully involved in decision making (M=3.94, SD=0.462) scored significantly higher on attitudes toward concordance than those who felt partially involved (M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p<0.001). Patients had an average score of 76.7% (SD=14.73%) on the Decision Self-Efficacy scale. In multiple linear regression analysis, ethnicity, number of medications taken by patients, patients' perceived level of involvement, and attitudes toward concordance are significant predictors of patients' self-efficacy in decision making (p<0.05).

    Conclusion: Patients who felt involved in their consultations had more positive attitudes toward concordance and higher confidence in making an informed decision. Further study is recommended on interventions involving pharmacists in supporting patients' involvement in medication-related decision making.

    MeSH terms: Analysis of Variance; Attitude; Chronic Disease; Cross-Sectional Studies; Decision Making; Hospitals, Public; Humans; Malaysia; Patient Participation; Perception; Pharmacists; Referral and Consultation; United States; Linear Models; Self Efficacy
  8. Xia N, Deng D, Wang Y, Fang C, Li SJ
    Int J Nanomedicine, 2018;13:2521-2530.
    PMID: 29731627 DOI: 10.2147/IJN.S154046
    Background: Prostate-specific antigen (PSA), a serine protease, is a biomarker for preoperative diagnosis and screening of prostate cancer and monitoring of its posttreatment.

    Methods: In this work, we reported a colorimetric method for clinical detection of PSA using gold nanoparticles (AuNPs) as the reporters. The method is based on ascorbic acid (AA)-induced in situ formation of AuNPs and Cu2+-catalyzed oxidation of AA. Specifically, HAuCl4 can be reduced into AuNPs by AA; Cu2+ ion can catalyze the oxidation of AA by O2 to inhibit the formation of AuNPs. In the presence of the PSA-specific peptide (DAHSSKLQLAPP)-modified gold-coated magnetic microbeads (MMBs; denoted as DAHSSKLQLAPP-MMBs), complexation of Cu2+ by the MMBs through the DAH-Cu2+ interaction depressed the catalyzed oxidation of AA and thus allowed for the formation of red AuNPs. However, once the peptide immobilized on the MMB surface was cleaved by PSA, the DAHSSKLQ segment would be released. The resultant LAPP fragment remaining on the MMB surface could not sequestrate Cu2+ to depress its catalytic activity toward AA oxidation. Consequently, no or less AuNPs were generated.

    Results: The linear range for PSA detection was found to be 0~0.8 ng/mL with a detection limit of 0.02 ng/mL. Because of the separation of cleavage step and measurement step, the interference of matrix components in biological samples was avoided.

    Conclusion: The high extinction coefficient of AuNPs facilitates the colorimetric analysis of PSA in serum samples. This work is helpful for designing of other protease biosensors by matching specific peptide substrates.

    MeSH terms: Ascorbic Acid/chemistry; Colorimetry/instrumentation; Colorimetry/methods*; Copper/chemistry; Gold/chemistry; Humans; Male; Prostatic Neoplasms; Biosensing Techniques/methods; Prostate-Specific Antigen/blood*; Metal Nanoparticles/chemistry*; Immobilized Proteins/metabolism; Immobilized Proteins/chemistry; Limit of Detection
  9. Harun SN, Nordin SA, Gani SSA, Shamsuddin AF, Basri M, Basri HB
    Int J Nanomedicine, 2018;13:2571-2584.
    PMID: 29731632 DOI: 10.2147/IJN.S151788
    Background and aim: Drugs that are effective against diseases in the central nervous system and reach the brain via blood must pass through the blood-brain barrier (BBB), a unique interface that protects against potential harmful molecules. This presents a major challenge in neuro-drug delivery. This study attempts to fabricate the cefuroxime-loaded nanoemulsion (CLN) to increase drug penetration into the brain when parenterally administered.

    Methods: The nanoemulsions were formulated using a high-pressure homogenization technique and were characterized for their physicochemical properties.

    Results: The characterizations revealed a particle size of 100.32±0.75 nm, polydispersity index of 0.18±0.01, zeta potential of -46.9±1.39 mV, viscosity of 1.24±0.34 cps, and osmolality of 285.33±0.58 mOsm/kg, indicating that the nanoemulsion has compatibility for parenteral application. CLN was physicochemically stable within 6 months of storage at 4°C, and the transmission electron microscopy revealed that the CLN droplets were almost spherical in shape. The in vitro release of CLN profile followed a sustained release pattern. The pharmacokinetic profile of CLN showed a significantly higher Cmax, area under the curve (AUC)0-
    t
    , prolonged half-life, and lower total plasma clearance, indicating that the systemic concentration of cefuroxime was higher in CLN-treated rats as compared to cefuroxime-free treated rats. A similar profile was obtained for the biodistribution of cefuroxime in the brain, in which CLN showed a significantly higher Cmax, AUC0-
    t
    , prolonged half-life, and lower clearance as compared to free cefuroxime solution.

    Conclusion: Overall, CLN showed excellent physicochemical properties, fulfilled the requirements for parenteral administration, and presented improved in vivo pharmacokinetic profile, which reflected its practical approach to enhance cefuroxime delivery to the brain.

    MeSH terms: Animals; Blood-Brain Barrier/drug effects; Brain/drug effects*; Cefuroxime/administration & dosage*; Cefuroxime/pharmacokinetics*; Drug Stability; Emulsions/administration & dosage*; Emulsions/chemistry; Half-Life; Humans; Male; Particle Size; Tissue Distribution; Viscosity; Drug Delivery Systems/methods*; Rats, Sprague-Dawley; Area Under Curve; Microscopy, Electron, Transmission; Nanostructures/administration & dosage; Nanostructures/chemistry; Drug Liberation
  10. Kared H, Martelli S, Tan SW, Simoni Y, Chong ML, Yap SH, et al.
    Front Immunol, 2018;9:686.
    PMID: 29731749 DOI: 10.3389/fimmu.2018.00686
    Repetitive stimulation by persistent pathogens such as human cytomegalovirus (HCMV) or human immunodeficiency virus (HIV) induces the differentiation of natural killer (NK) cells. This maturation pathway is characterized by the acquisition of phenotypic markers, CD2, CD57, and NKG2C, and effector functions-a process regulated by Tim-3 and orchestrated by a complex network of transcriptional factors, involving T-bet, Eomes, Zeb2, promyelocytic leukemia zinc finger protein, and Foxo3. Here, we show that persistent immune activation during chronic viral co-infections (HCMV, hepatitis C virus, and HIV) interferes with the functional phenotype of NK cells by modulating the Tim-3 pathway; a decrease in Tim-3 expression combined with the acquisition of inhibitory receptors skewed NK cells toward an exhausted and cytotoxic phenotype in an inflammatory environment during chronic HIV infection. A better understanding of the mechanisms underlying NK cell differentiation could aid the identification of new immunological targets for checkpoint blockade therapies in a manner that is relevant to chronic infection and cancer.
    MeSH terms: Cytomegalovirus Infections/immunology*; Hepatitis C/immunology*; Humans; Killer Cells, Natural/immunology*; HIV Infections/immunology*; Antigens, CD57/immunology; NK Cell Lectin-Like Receptor Subfamily C/immunology; Coinfection/immunology*; Hepatitis A Virus Cellular Receptor 2/immunology*
  11. Cheng V, Abdul-Aziz MH, Roberts JA, Shekar K
    J Thorac Dis, 2018 Mar;10(Suppl 5):S629-S641.
    PMID: 29732181 DOI: 10.21037/jtd.2017.09.154
    Optimal pharmacological management during extracorporeal membrane oxygenation (ECMO) involves more than administering drugs to reverse underlying disease. ECMO is a complex therapy that should be administered in a goal-directed manner to achieve therapeutic endpoints that allow reversal of disease and ECMO wean, minimisation of complications (treatment of complications when they do occur), early interruption of sedation and rehabilitation, maximising patient comfort and minimising risks of delirium. ECMO can alter both the pharmacokinetics (PK) and pharmacodynamics (PD) of administered drugs and our understanding of these alterations is still evolving. Based on available data it appears that modern ECMO circuitry probably has a less significant impact on PK when compared with critical illness itself. However, these findings need further confirmation in clinical population PK studies and such studies are underway. The altered PD associated with ECMO is less understood and more research is indicated. Until robust dosing guidelines become available, clinicians will have to rely on the principles of drug dosing in critically ill and known PK alterations induced by ECMO itself. This article summarises the PK alterations and makes preliminary recommendations on possible dosing approaches.
    MeSH terms: Delirium; Goals; Humans; Medicine; Research; Risk; Extracorporeal Membrane Oxygenation; Critical Illness; Patient Comfort
  12. Ibrahim MMA, Ghadzi SMS, Kjellsson MC, Karlsson MO
    CPT Pharmacometrics Syst Pharmacol, 2018 07;7(7):432-441.
    PMID: 29732710 DOI: 10.1002/psp4.12302
    In antidiabetic drug development, phase I studies usually involve short-term glucose provocations. Multiple designs are available for these provocations (e.g., meal tolerance tests (MTTs) and graded glucose infusions (GGIs)). With a highly nonlinear, complex system as the glucose homeostasis, the various provocations will contribute with different information offering a rich choice. Here, we investigate the most appropriate study design in phase I for several hypothetical mechanisms of action of a study drug. Five drug effects in diabetes therapeutic areas were investigated using six study designs. Power to detect drug effect was assessed using the likelihood ratio test, whereas precision and accuracy of the quantification of drug effect was assessed using stochastic simulation and estimations. An overall summary was developed to aid designing the studies of antihyperglycemic drug development using model-based analysis. This guidance is to be used when the integrated glucose insulin model is used, involving the investigated drug mechanisms of action.
    MeSH terms: Drug Evaluation; Glucose; Homeostasis; Hypoglycemic Agents; Insulins; Meals
  13. Lee HL, Chua SS, Mahadeva S
    J Dig Dis, 2018 Jun;19(6):342-349.
    PMID: 29732728 DOI: 10.1111/1751-2980.12607
    OBJECTIVE: To evaluate regular non-steroidal anti-inflammatory drug (NSAID) users for dyspepsia, as well as to assess the effect of preventive measures, and the reasons for non-adherence to gastroprotective agents (GPA) from a real-world perspective.
    METHODS: A prospective longitudinal study was conducted among outpatients with regular NSAID usage. The presence of dyspepsia was assessed by locally validated versions of the Leeds dyspepsia questionnaire (LDQ), GPA and the participants' adherence to the drugs were assessed at recruitment and 2 weeks later. GPA was defined as the use of antisecretory medications or cyclooxygenase-2 inhibitors.
    RESULTS: Initially, 409 participants (mean age 52.3 ± 14.6 years, 60.6% females, 48.4% treated for musculoskeletal pain) were recruited. At recruitment, 50.9% of the participants had at least one upper gastrointestinal symptom. Complete data for follow-up analysis were collected from 158 participants who were naive NSAID users, had no prior gastrointestinal medication and who could be contacted. At 2-week follow-up there was no significant difference in the LDQ score change between NSAID users treated with GPA and those did not. However, there was a greater reduction in abdominal pain/discomfort (8.8% vs 5.0%, P 
    MeSH terms: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage; Anti-Inflammatory Agents, Non-Steroidal/adverse effects*; Anti-Ulcer Agents/therapeutic use; Drug Administration Schedule; Dyspepsia/chemically induced*; Dyspepsia/prevention & control*; Female; Histamine H2 Antagonists/therapeutic use; Hospitals, University; Humans; Longitudinal Studies; Malaysia; Male; Middle Aged; Outpatient Clinics, Hospital; Pharmacies; Prospective Studies; Chemoprevention; Cyclooxygenase 2 Inhibitors/therapeutic use; Proton Pump Inhibitors/therapeutic use; Medication Adherence/statistics & numerical data; Young Adult
  14. Ya'acob NA, Abidin EZ, Rasdi I, Rahman AA, Ismail S
    Work, 2018;60(1):143-152.
    PMID: 29733032 DOI: 10.3233/WOR-182711
    BACKGROUND: Work tasks in pineapple plantations in Malaysia are characterised by non-ergonomic work postures, repetitive tasks, awkward posture and manual handling of work tools that contribute to the reporting of musculoskeletal symptoms (MSS). There have been very limited studies performed among pineapple plantation workers focusing on ergonomic intervention programs to specifically reduce MSS.

    OBJECTIVE: The aim of this study was to assess the effects of work improvement module using a Kiken Yochi participatory approach intervention in reducing MSS among male migrant pineapple farm plantation workers in Pontian, Johor.

    METHODOLOGY: In this interventional study, a total of 68 male migrant workers from two plantation farms were invited to become a participant in this study. In total, 45 participants that consisted of 27 workers for the intervention group and 18 workers for the control group were recruited. The background of workers and MSS were assessed using questionnaires. Ergonomic and postural risks were evaluated and the work tasks with the highest risk were used as a basis for the development of the Kiken Yochi training module. MSS education and training intervention that provided information on proper lifting techniques and education on body mechanics and ergonomics to reduce MSS were implemented to both groups of workers. Kiken Yochi Training was given to the intervention group only. MSS were reassessed after 2 months of the follow-up period. Data was entered into statistical software and were analysed according to objectives.

    RESULTS: In terms of the postural risk assessment, almost two-third of the participants (68.5%) had working postures categorized as high risk for MSS. Ergonomic risk assessment identified cultivation, manual weeding and harvesting of pineapples as the work tasks contributing the highest health risks to workers. The most commonly reported MSS between both groups of workers were at the knees, lower back and shoulder area. Upon completion of the delivery of intervention module to both groups of workers, the MSS prevalence reported (after 2 months) were significantly lower for the ankles and feet area within the intervention group.

    CONCLUSION: This study suggested that development and implementation of programs using effective participatory approach training methods are able to prevent selected musculoskeletal problems for this occupation. To enhance the effects of such trainings, modifications of work tools in this occupation are desirable.

    MeSH terms: Farmers/statistics & numerical data*; Adult; Humans; Malaysia; Male; Middle Aged; Musculoskeletal Diseases/epidemiology; Musculoskeletal Diseases/prevention & control; Surveys and Questionnaires; Teaching/standards*; Teaching/trends; Ananas*; Occupational Injuries/epidemiology; Occupational Injuries/prevention & control*; Farms/statistics & numerical data
  15. Shawal FNS, Guan NY, Mohd Suadi Nata DH, How V, Tamrin SBM
    Work, 2018;60(1):153-162.
    PMID: 29733040 DOI: 10.3233/WOR-182725
    BACKGROUND: People who work with the steam boilers in palm oil mills are vulnerable to accidents, notably to explosions, whenever failures of any kind occur during their operation.

    OBJECTIVE: This cross-sectional study was conducted in palm oil mills to determine the knowledge, attitude, and perception (KAP) concerning the risk management of steam boilers among workers in palm oil mills.

    METHODS: A total of 50 workers who were working with steam boilers and/or involved in managing the operation of steam boilers with at least three years of working experience in the palm oil industry were purposively sampled. A self-administrated questionnaire consisting of four main parts - socio-demographic and occupational information, knowledge, attitude, and perception of the risk management of steam boilers was distributed. The knowledge, attitude, and perception were calculated based on a Likert-type scale.

    RESULTS: This study found that 56% of boiler workers had a good level of knowledge (mean score = 77.22±19.6), 72% had a good attitude toward risk (mean score = 83.17±5.85), and 64% had a good perception of risk (mean score = 79.50±11.22). The prevalence of accidents was 16%, and, for near misses, it was 24%. The cause of the reported accidents was largely attributed to carelessness, specifically at 80%. Apart from that, there was a positive association (χ2 = 6.56; p = 0.010) between attitude and accidents.

    CONCLUSION: This study found that the workers had good KAP levels of risk management of steam boilers in palm oil mills. However, there is a need for the employers to revise the training of workers and ensure its effectiveness in heightening the awareness of risks and accidents despite the high level of KAP.

    MeSH terms: Farmers/psychology*; Adult; Cross-Sectional Studies; Humans; Health Knowledge, Attitudes, Practice*; Male; Middle Aged; Perception; Surveys and Questionnaires; Risk Management/methods; Risk Management/standards*; Steam/adverse effects; Prevalence; Manufacturing and Industrial Facilities*
  16. Chong LA, Chong PH, Chee J
    J Palliat Med, 2018 09;21(9):1242-1248.
    PMID: 29733235 DOI: 10.1089/jpm.2017.0626
    BACKGROUND: The provision of pediatric palliative care in Asia Pacific varies between countries and availability of essential medications for symptoms at the end of life in this region is unclear.

    OBJECTIVE: To determine medications available and used in the management of six symptoms at the end of life among pediatric palliative care practitioners in Asia Pacific. To identify alternative pharmacological strategies for these six symptoms if the oral route was no longer possible and injections are refused.

    DESIGN AND SETTING: An online survey of all Asia Pacific Hospice Palliative Care Network (APHN) members was carried out to identify medications used for six symptoms (pain, dyspnea, excessive respiratory secretions, nausea/vomiting, restlessness, seizures) in dying children. Two scenarios were of interest: (1) hours to days before death and (2) when injectables were declined or refused.

    RESULTS: There were 54 responses from 18 countries. Majority (63.0%) of respondents were hospital based. About half of all respondents were from specialist palliative care services and 55.6% were from high-income countries. All respondents had access to essential analgesics. Several perceived that there were no available drugs locally to treat the five other commonly encountered symptoms. There was a wide variation in preferred drugs for treating each symptom that went beyond differences in drug availability or formulations.

    CONCLUSION: Future studies are needed to explore barriers to medication access and possible knowledge gaps among service providers in the region, so that advocacy and education endeavors by the APHN may be optimized.

    MeSH terms: Asia; Child; Female; Humans; Male; Pacific Islands; Palliative Care/methods*; Quality of Life; Surveys and Questionnaires; Terminal Care/methods*; Hospice Care*; Drugs, Essential/supply & distribution*; Pain Management/methods*
  17. Aung AK, Tang MJ, Adler NR, de Menezes SL, Goh MSY, Tee HW, et al.
    J Clin Pharmacol, 2018 10;58(10):1332-1339.
    PMID: 29733431 DOI: 10.1002/jcph.1148
    We describe adverse drug reaction (ADR) reporting characteristics and factors contributing to length of time to report by healthcare professionals. This is a retrospective study of voluntary reports to an Australian healthcare ADR Review Committee over a 2-year period (2015-2016). Descriptive and univariate models were used for outcomes, employing standardized ADR definitions. Hospital pharmacists reported 84.8% of the 555 ADRs: 70.3% were hospital onset reactions, and 71.7% were at least of moderate severity. Immunologically mediated reactions were most commonly reported (409, 73.7%). The median time to submit an ADR report was 3 (interquartile range 1-10) days. Longer median times to reporting were associated with multiple implicated agents and delayed hypersensitivity reactions, especially severe cutaneous adverse reactions. A total of 650 medications were implicated that involved multiple agents in 165/555 (29.7%) reports. Antimicrobials were the most commonly implicated agents. Immunologically mediated reactions were most commonly associated with antimicrobials and radiocontrast agents (P < .0001, odds ratio [OR] 3.6, 95%CI 2.4-5.5, and P = .04, OR 4.2, 95%CI 1.2-18.2, respectively). Opioids and psychoactive medications were more commonly implicated in nonimmunological reported ADRs (P = .0002, OR 3.9, 95%CI 1.9-7.9, and P < .0001, OR 11.4, 95%CI 4.6-27.8, respectively). Due to the predominant reporting of immunologically mediated reactions, a targeted education program is being planned to improve identification and accuracy of ADR reports, with the overall aim of improved management to ensure quality service provision and patient safety.
    MeSH terms: Australia/epidemiology; Health Personnel*; Humans; Retrospective Studies; Adverse Drug Reaction Reporting Systems*; Pharmacovigilance*; Patient Safety*; Drug-Related Side Effects and Adverse Reactions/epidemiology*
  18. Kwan MK, Chiu CK, Tan PH, Chian XH, Ler XY, Ng YH, et al.
    Spine J, 2018 12;18(12):2239-2246.
    PMID: 29733900 DOI: 10.1016/j.spinee.2018.05.007
    BACKGROUND CONTEXT: In Lenke 1C and 2C curves, the choice between selective thoracic fusion (STF) versus non-selective thoracic fusion as the optimal surgical treatment is controversial.

    OBJECTIVE: This study aimed to assess the radiological and clinical outcome of patients with Lenke 1C and 2C curves treated with STF.

    STUDY DESIGN: This is a retrospective study.

    PATIENT SAMPLE: A total of 44 patients comprised the study sample.

    METHODS: Forty-four patients with Lenke 1C and 2C curves with adolescent idiopathic scoliosis who underwent STF were reviewed. Radiological parameters and Scoliosis Research Society (SRS)-22r scores were assessed preoperatively, postoperatively, and on final follow-up. The incidence of coronal decompensation, lumbar decompensation, and adding-on phenomenon were reported.

    RESULTS: Mean follow-up duration was 45.1±12.3 months and mean age was 17.0±5.1 years. The preoperative middle thoracic and thoracolumbar/lumbar (MT:TL/L) Cobb angle ratio was 1.4±0.3 and the MT:TL/L apical vertebra translation (AVT) ratio was 1.6±0.8. Final follow-up coronal balance was -13.0±11.5 mm, main thoracic AVT was 6.9±11.8 mm, and lumbar AVT was -20.4±13.8 mm (p

    MeSH terms: Adolescent; Child; Female; Humans; Lumbar Vertebrae/surgery; Male; Postoperative Complications/epidemiology*; Radiography; Scoliosis/surgery*; Spinal Fusion/adverse effects*; Spinal Fusion/methods; Thoracic Vertebrae/surgery*; Young Adult
  19. Rama Rao S, Liew TS, Yow YY, Ratnayeke S
    PLoS One, 2018;13(5):e0196582.
    PMID: 29734361 DOI: 10.1371/journal.pone.0196582
    Invasive snails in the genus Pomacea have spread across Southeast Asia including Peninsular Malaysia. Their effects on natural and agricultural wetlands are appreciable, but species-specific effects are less clear because of morphological similarity among the species. Our objective was to establish diagnostic characteristics of Pomacea species in Malaysia using genetic and morphological criteria. The mitochondrial COI gene of 52 adult snails from eight localities in Peninsular Malaysia was amplified, sequenced, and analysed to verify species and phylogenetic relationships. Shells were compared using geometric morphometric and covariance analyses. Two monophyletic taxa, P. canaliculata and P. maculata, occurred in our samples. The mean ratio of shell height: aperture height (P = 0.042) and shell height: shell width (P = 0.007) was smaller in P. maculata. P. maculata co-occurred with P. canaliculata in five localities, but samples from three localities contained only P. canaliculata. This study is the first to confirm the presence of two of the most invasive species of Pomacea in Peninsular Malaysia using a molecular technique. P. canaliculata appears to be the more widespread species. Despite statistical differences, both quantitative and qualitative morphological characteristics demonstrated much interspecific overlap and intraspecific variability; thus, shell morphology alone cannot reliably verify species identity. Molecular techniques for distinguishing between these two highly invasive Pomacea species are needed to understand their specific ecological niches and to develop effective protocols for their management.
    MeSH terms: Animals; Base Sequence; Ecology; Malaysia; Phylogeny; Snails/cytology*; Snails/genetics*; Species Specificity; Genes, Mitochondrial/genetics; Introduced Species; Animal Shells/anatomy & histology
  20. Ping KS, Poobathy RR, Zakaria R, Subramaniam S
    Cryo Letters, 2018 5 8;38(4):290-298.
    PMID: 29734430
      BACKGROUND: Conservation of commercially important ornamental plants is important to maintain its unique beauty to cater the market demands.

    OBJECTIVE: The main objective is to develop an efficient cryopreservation technique for Aranda Broga Blue orchid PLBs using droplet-vitrification method.

    MATERIALS AND METHODS: Several critical factors in cryopreservation were accessed such as preculture concentrations and durations, choice of vitrification solutions, two-step or three-step vitrification, growth recovery medium and PVS2 exposure duration.

    RESULTS: The best growth regeneration percentage (5%) was obtained when 3-4mm PLBs were precultured in 0.2M sucrose for 3 days, followed by osmoprotection for 20 minutes, dehydration in PVS2 for 20 minutes at 0 degree C, LN storage, thawed and unloading for 20 minutes, and growth regeneration in VW10 medium. PLBs were found to be very sensitive to osmotic stress imposed by high molecular weight cryoprotectant such as sucrose and glycerol. Osmotic potential of growth recovery medium is one of the main factors that affect growth recovery in cryopreserved PLBs.

    CONCLUSION: Current report showed possibilities in cryopreserving Aranda Broga Blue PLBs using droplet-vitrification technique. However, further improvement of growth recovery can be done by focussing on approaches that facilitate sufficient water removal from PLBs without causing severe osmotic injuries to the plant cells.

    MeSH terms: Cryoprotective Agents/pharmacology*; Culture Media; Desiccation; Glycerol/pharmacology; Osmotic Pressure; Regeneration/drug effects; Sucrose/pharmacology; Water/chemistry; Cryopreservation/methods*; Orchidaceae/anatomy & histology*; Orchidaceae/drug effects; Orchidaceae/physiology*; Vitrification*
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