Browse publications by year: 2020

Pay-for-performance challenges in family physician program

Gharibi F, Dadgar E

Malays Fam Physician, 2020;15(2):19-29.
PMID: 32843941

Objective: This study was conducted to investigate the challenges faced in the implementation of the pay-for-performance system in Iran's family physician program.
Study design: Qualitative.
Place and duration of study: The study was conducted with 32 key informants at the family physician program at the Tabriz University of Medical Sciences between May 2018 and June 2018. Method: This is a qualitative study. A purposeful sampling method was used with only one inclusion criterion for participants: five years of experience in the family physician program. The researchers conducted 17 individual and group non-structured interviews and examined participants' perspectives on the challenges faced in the implementation of the pay-for-performance system in the family physician program. Content analysis was conducted on the obtained data.
Results: This study identified 7 themes, 14 sub-themes, and 46 items related to the challenges in the implementation of pay-for-performance systems in Iran's family physician program. The main themes are: workload, training, program cultivation, payment, assessment and monitoring, information management, and level of authority. Other sub-challenges were also identified.
Conclusion: The study results demonstrate some notable challenges faced in the implementation of the pay-for-performance system. This information can be helpful to managers and policymakers.

MeSH terms: Group Processes; Group Structure; Humans; Iran; Physicians, Family; Reimbursement, Incentive; Research Personnel; Workload; Information Management; Qualitative Research
Chronic non-healing ulcers as presenting sign of acquired immunodeficiency syndrome

Nasiri S, Barat T, Bidari-Zerehpoosh F, Mozafari N

Malays Fam Physician, 2020;15(2):30-33.
PMID: 32843942

Atypical forms of herpes simplex virus (HSV) infections, which indicate severe impairment of cellular immunity can be challenging to diagnose. In this paper, we report the case of an atypical HSV infection presenting as chronic nonhealing wounds, which are the first sign of HIV, in a 50-year-old female patient. The lesions had emerged as two large, chronic, and painful ulcerations on the left buttock and labia major 8 months prior. The skin biopsy revealed multinucleated keratinocytes with ground glass nuclei and intranuclear Cowdry type A viral inclusions. A serologic test for HIV-1 was positive. Her CD4+ T-cell count was 42/mm3. Clinicians should be familiar with the dermatologic manifestations of HIV, as they are occasionally key to correctly suspecting an underlying HIV infection, allowing for early diagnosis and treatment.

MeSH terms: Biopsy; Buttocks; Female; Herpes Simplex; HIV Seropositivity; Humans; Immunity, Cellular; Middle Aged; Serologic Tests; CD4-Positive T-Lymphocytes; HIV-1; Keratinocytes; HIV Infections; Simplexvirus; Early Diagnosis
Fulltext Maternal obesity and its determinants: A neglected issue?

Nurul-Farehah S, Rohana AJ

Malays Fam Physician, 2020;15(2):34-42.
PMID: 32843943

Maternal obesity is a global public health concern that affects every aspect of maternity care. It affects the short-term and long-term health of the mother and her offspring. Obese pregnant mothers are at an increased risk of developing complications during antenatal, intrapartum, and postnatal periods. Maternal complications include gestational diabetes mellitus, hypertensive disorder in pregnancy, pre-eclampsia and eclampsia, increased rate of cesarean delivery, pulmonary embolism, and maternal mortality; fetal complications include congenital malformation, stillbirth, and macrosomia. Moreover, both mother and infant are at an increased risk of developing subsequent non-communicable diseases and cardiovascular problems later in life. Several factors are associated with the likelihood of maternal obesity, including sociodemographic characteristics, obstetric characteristics, knowledge, and perception of health-promoting behavior. Gaining a sound understanding of these factors is vital to reaching the targets of Sustainable Developmental Goal 3-to reduce global maternal mortality and end preventable deaths of children under 5 years of age-by 2030. It is essential to identify pregnant women who are at risk of maternal obesity in order to plan and implement effective and timely interventions for optimal pregnancy outcomes. Importantly, maternal obesity as a significant pregnancy risk factor is largely modifiable.

MeSH terms: Cesarean Section; Child; Child, Preschool; Eclampsia; Female; Fetal Macrosomia; Goals; Humans; Infant; Maternal Health Services; Maternal Mortality; Mothers; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Prenatal Care; Public Health; Risk Factors; Diabetes, Gestational; Stillbirth
The implication of stigma on people living with HIV and the role of social support - A case report

Hadi AM, Lee PY, Adibah HI

Malays Fam Physician, 2020;15(2):43-45.
PMID: 32843944

Despite the advancements made in the knowledge and treatment of the human immunodeficiency virus (HIV) since it was first discovered, people living with HIV (PLWH) continue to be stigmatized. This paper presents the case of an HIV-infected patient who delayed the necessary treatment due to stigma and ultimately presented with AIDS. Through social support, however, he was able to overcome his internalized stigma; he was finally willing to start on antiretroviral treatment (ART). This case report addresses the effect of stigma on and the role of social support in the management of an individual with HIV.

MeSH terms: Acquired Immunodeficiency Syndrome; HIV; Humans; Male; Stereotyping; HIV Infections; Anti-Retroviral Agents; Social Stigma
An infant with kwashiorkor: The forgotten disease

Kamaruzaman NA, Jamani NA, Said AH

Malays Fam Physician, 2020;15(2):46-49.
PMID: 32843945

Undernutrition remains a major public health concern, especially in developing countries. Despite being rich in resources, Malaysia is still home to children suffering from severe undernutrition. This paper presents the case of a 5-month-old boy with kwashiorkor stemming from improper weaning which was overlooked. This case highlights the importance of recognizing the early signs of kwashiorkor to allow for early referrals for proper management and prevent its possible complications.

MeSH terms: Child; Developing Countries; Health Resources; Humans; Infant; Kwashiorkor; Malaysia; Male; Protein-Energy Malnutrition; Public Health; Referral and Consultation; Weaning
An unusual cause of acute abdomen and acute renal failure: Djenkolism

Sumitro K, Yong CS, Tan LT, Choo S, Lim CY, Shariman H, et al.

Malays Fam Physician, 2020;15(2):50-52.
PMID: 32843946

The djenkol bean (Archidendron pauciflorum) is a native delicacy in Southeast Asia, though consumption can sometimes lead to djenkolism. Clinical features of djenkolism include acute abdominal pain, hematuria, urinary retention, and acute kidney injury (AKI). The pain can be severe, which often leads to a misdiagnosis of acute abdomen. In this paper, we report the case of an Indonesian migrant with djenkolism. Due to the short history and severity of the abdominal pain, medical professionals suspected acute abdomen and proceeded with a negative exploratory laparotomy. However, djenkolism was suspected once relatives informed the professionals that the patient had consumed djenkol beans hours earlier. The patient recovered through aggressive hydration and urine alkalinization with bicarbonate infusion. We highlight the importance of being aware of this rare cause of AKI, especially in Southeast Asia, in order to provide early diagnoses and prompt treatments.

MeSH terms: Abdomen, Acute; Bicarbonates; Diagnostic Errors; Hematuria; Humans; Indonesia; Laparotomy; Transients and Migrants; Abdominal Pain; Urinary Retention; Early Diagnosis; Acute Kidney Injury
A hard left supraclavicular mass in a young boy-is it cancer?

Ramasamy K, Saniasiaya J, Gani NA

Malays Fam Physician, 2020;15(2):53-55.
PMID: 32843947
Letter to the editor regarding the article, "young lady with bilateral yellowish lesions on her eyelids"

Hisham A, Md Mydin Siddik N, Ibrahim S, Mohd Yussof SJ

Malays Fam Physician, 2020;15(2):56-57.
PMID: 32843948
COVID-19, family medicine, and primary care centers

Mungmungpuntipantip R, Wiwanitkit V

Malays Fam Physician, 2020;15(2):58.
PMID: 32843949
Fulltext 2-[(1E)-[(Z)-2-({[(1Z)-[(E)-2-[(2-Hy-droxy-phen-yl)methyl-idene]hydrazin-1-yl-idene]({[(4-methyl-phen-yl)meth-yl]sulfan-yl})meth-yl]disulfan-yl}({[(4-methyl-phen-yl)meth-yl]sulfan-yl})methyl-idene)hydrazin-1-yl-idene]meth-yl]phenol: crystal structure, Hirshfeld surface analysis and computational study

Paulus G, Kwong HC, Crouse KA, Tiekink ERT

Acta Crystallogr E Crystallogr Commun, 2020 Aug 01;76(Pt 8):1245-1250.
PMID: 32844007 DOI: 10.1107/S2056989020008762

The complete mol-ecule of the title hydrazine carbodi-thio-ate derivative, C32H30N4O2S4, is generated by a crystallographic twofold axis that bis-ects the di-sulfide bond. The mol-ecule is twisted about this bond with the C-S-S-C torsion angle of 90.70 (8)° indicating an orthogonal relationship between the symmetry-related halves of the mol-ecule. The conformation about the imine bond [1.282 (2) Å] is E and there is limited delocalization of π-electron density over the CN2C residue as there is a twist about the N-N bond [C-N-N-C torsion angle = -166.57 (15)°]. An intra-molecular hydroxyl-O-H⋯N(imine) hydrogen bond closes an S(6) loop. In the crystal, methyl-ene-C-H⋯π(tol-yl) contacts assemble mol-ecules into a supra-molecular layer propagating in the ab plane: the layers stack without directional inter-actions between them. The analysis of the calculated Hirshfeld surfaces confirm the importance of H⋯H contacts, which contribute 46.7% of all contacts followed by H⋯C/C⋯H contacts [25.5%] reflecting, in part, the C-H⋯π(tol-yl) contacts. The calculation of the inter-action energies confirm the importance of the dispersion term and the influence of the stabilizing H⋯H contacts in the inter-layer region.
Fulltext [(Z)-N-(3-Fluoro-phen-yl)-O-methyl-thio-carbamato-κS](tri-phenyl-phosphane-κP)gold(I): crystal structure, Hirshfeld surface analysis and computational study

Yeo CI, Tan SL, Kwong HC, Tiekink ERT

Acta Crystallogr E Crystallogr Commun, 2020 Aug 01;76(Pt 8):1284-1290.
PMID: 32844015 DOI: 10.1107/S2056989020009469

The title phosphanegold(I) thiol-ate, C26H22AuFNOPS or [Au(C8H7FNOS)(C18H15P)], has the AuI centre coordinated by phosphane-P [2.2494 (8) Å] and thiol-ate-S [2.3007 (8) Å] atoms to define a close to linear geometry [P-Au-S = 176.10 (3)°]. The thiol-ate ligand is orientated so that the meth-oxy-O atom is directed towards the Au atom, forming an Au⋯O close contact of 2.986 (2) Å. In the crystal, a variety of inter-molecular contacts are discerned with fluoro-benzene-C-H⋯O(meth-oxy) and phenyl-C-H⋯F inter-actions leading to dimeric aggregates. These are assembled into a three-dimensional architecture by phenyl-C-H⋯S(thiol-ate) and phenyl-C-H⋯π(fluorobenzene, phen-yl) inter-actions. Accordingly, the analysis of the calculated Hirshfeld surface shows 30.8% of all contacts are of the type C⋯H/H⋯C but this is less than the H⋯H contacts, at 44.9%. Other significant contributions to the surface come from H⋯F/F⋯H [8.1%], H⋯S/S⋯H [6.9%] and H⋯O/O⋯H [3.2%] contacts. Two major stabilization energies have contributions from the phenyl-C-H⋯π(fluoro-benzene) and fluoro-benzene-C-H⋯C(imine) inter-actions (-37.2 kcal mol-1), and from the fluoro-benzene-C-H⋯F and phenyl-C-H⋯O inter-actions (-34.9 kcal mol-1), the latter leading to the dimeric aggregate.
Fulltext DNA barcoding of commercially important reef fishes in Weh Island, Aceh, Indonesia

Fadli N, Mohd Nor SA, Othman AS, Sofyan H, Muchlisin ZA

PeerJ, 2020;8:e9641.
PMID: 32844060 DOI: 10.7717/peerj.9641

Knowledge on the precise identification of fish resources is critical for sustainable fisheries management. This study employs the DNA barcoding approach to generate a molecular taxonomic catalogue of commercially important reef fishes in the waters of Weh Island (Aceh Province), the most northerly inhabited island in the biodiverse Indonesian Archipelago. The waters not only support artisanal fisheries but also a feeder for the industry in the greater island of Aceh. In total, 230 specimens from 72 species belonging to 32 genera and 17 families were DNA barcoded, representing a major segment of the captured reef fish taxa and a quarter of fish species diversity that had previously been recorded. The sequence read lengths were 639 bp revealing 359 conserved sites, 280 variable sites, 269 parsimony informative and 11 singletons. Our molecular findings paralleled the morphological identification with no evidence of cryptic species or new species discovery. This study is a significant contribution to the fisheries statistics of this area, which would facilitate assessment of species catch composition and hence for strategizing management plans. It is an important input to the DNA barcode library of Indonesian marine fishes and to the global DNA barcode entries in general.

MeSH terms: Animals; DNA; Fisheries; Fishes; Indonesia; Gene Library; Biodiversity; DNA Barcoding, Taxonomic; Islands
Fulltext Recent population expansion of longtail tuna Thunnus tonggol (Bleeker, 1851) inferred from the mitochondrial DNA markers

Syahida Kasim N, Mat Jaafar TNA, Mat Piah R, Mohd Arshaad W, Mohd Nor SA, Habib A, et al.

PeerJ, 2020;8:e9679.
PMID: 32844067 DOI: 10.7717/peerj.9679

The population genetic diversity and demographic history of the longtail tuna Thunnus tonggol in Malaysian waters was investigated using mitochondrial DNA D-loop and NADH dehydrogenase subunit 5 (ND5). A total of 203 (D-loop) and 208 (ND5) individuals of T. tonggol were sampled from 11 localities around the Malaysian coastal waters. Low genetic differentiation between populations was found, possibly due to the past demographic history, dispersal potential during egg and larval stages, seasonal migration in adults, and lack of geographical barriers. The gene trees, constructed based on the maximum likelihood method, revealed a single panmictic population with unsupported internal clades, indicating an absence of structure among the populations studied. Analysis on population pairwise comparison ФST suggested the absence of limited gene flow among study sites. Taken all together, high haplotype diversity (D-loop = 0.989-1.000; ND5 = 0.848-0.965), coupled with a low level of nucleotide diversity (D-loop = 0.019-0.025; ND5 = 0.0017-0.003), "star-like" haplotype network, and unimodal mismatch distribution, suggests a recent population expansion for populations of T. tonggol in Malaysia. Furthermore, neutrality and goodness of fit tests supported the signature of a relatively recent population expansion during the Pleistocene epoch. To provide additional insight into the phylogeographic pattern of the species within the Indo-Pacific Ocean, we included haplotypes from GenBank and a few samples from Taiwan. Preliminary analyses suggest a more complex genetic demarcation of the species than an explicit Indian Ocean versus Pacific Ocean delineation.
CORRIGENDUM TO: PHOTON FIELD OF ~100-200 KEV FOR ENVIRONMENTAL DOSEMETER CALIBRATION

Tajudin SM, Namito Y, Sanami T, Hirayama H

Radiat Prot Dosimetry, 2020 Sep 16;190(3):353.
PMID: 32844231 DOI: 10.1093/rpd/ncaa122
Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial fibrillation

Leong MC, Kandavello G, Husin A, Perumal D, Kaur Khelae S

Pacing Clin Electrophysiol, 2020 11;43(11):1252-1257.
PMID: 32845014 DOI: 10.1111/pace.14049

BACKGROUND: Elderly patients with atrial septal defect (ASD) often present with chronic atrial fibrillation and large left to right shunt. This study reports the experience of left atrial appendage (LAA) and ASD closure in patients with significant ASD and chronic atrial fibrillation.
METHODS: We report six consecutive elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure from January 1, 2014 until December 31, 2019. All periprocedural and long-term (>1 year) outcomes were reported.
RESULTS: Six patients (male: 33.3%; mean age: 66.8 ± 3.3 years) were included. Mean CHADS2 , CHA2 DS2 -VASc , and HAS-BLED scores were 2.33 ± 0.82, 3.83 ± 0.75, and 1.83 ± 0.75. Four patients underwent simultaneous procedure, while two patients underwent a staged procedure. Procedural success was achieved in all patients. Total occlusion was achieved during LAA occlusion without device embolization prior to ASD closure. Patients who underwent simultaneous procedure had a shorter total hospital stay and lower total hospital stay. During a follow-up period of 32.8 ± 19.4 months, both the devices were well seated. No device-related thrombosis or erosion reported. All patients remained in atrial fibrillation. No patients experienced any thromboembolic stroke or transient ischemic attack.
CONCLUSIONS: LAA and ASD closure is feasible and can be safely performed in the same seating in elderly patients with a significant ASD.

MeSH terms: Aged; Atrial Fibrillation; Ischemic Attack, Transient; Follow-Up Studies; Heart Septal Defects, Atrial; Humans; Length of Stay; Male; Middle Aged; Thromboembolism; Thrombosis; Atrial Appendage; Stroke
Implementing Society of Surgical Oncology and the American Society for Radiation Oncology Margin Guidelines to Reduce Reoperations After Lumpectomy for Early Breast Cancer

Yip CH

JAMA Surg, 2020 10 01;155(10):e203026.
PMID: 32845278 DOI: 10.1001/jamasurg.2020.3026
Shotgun metagenomics reveals a heterogeneous prokaryotic community and a wide array of antibiotic resistance genes in mangrove sediment

Imchen M, Kumavath R

FEMS Microbiol Ecol, 2020 10 01;96(10).
PMID: 32845305 DOI: 10.1093/femsec/fiaa173

Saline tolerant mangrove forests partake in vital biogeochemical cycles. However, they are endangered due to deforestation as a result of urbanization. In this study, we have carried out a metagenomic snapshot of the mangrove ecosystem from five countries to assess its taxonomic, functional and antibiotic resistome structure. Chao1 alpha diversity varied significantly (P 90% relative abundance. Comparative analysis of mangrove with terrestrial and marine ecosystems revealed the strongest heterogeneity in the mangrove microbial community. We also observed that the mangrove community shared similarities to both the terrestrial and marine microbiome, forming a link between the two contrasting ecosystems. The antibiotic resistant genes (ARG) resistome was comprised of nineteen level 3 classifications dominated by multidrug resistance efflux pumps (46.7 ± 4.3%) and BlaR1 family regulatory sensor-transducer disambiguation (25.2 ± 4.8%). ARG relative abundance was significantly higher in Asian countries and in human intervention datasets at a global scale. Our study shows that the mangrove microbial community and its antibiotic resistance are affected by geography as well as human intervention and are unique to the mangrove ecosystem. Understanding changes in the mangrove microbiome and its ARG is significant for sustainable development and public health.

MeSH terms: Brazil; China; Drug Resistance, Microbial/genetics; Humans; India; Malaysia; Saudi Arabia; Wetlands; Metagenomics*
Measurements of tt[over ¯]H Production and the CP Structure of the Yukawa Interaction between the Higgs Boson and Top Quark in the Diphoton Decay Channel

Sirunyan AM, Tumasyan A, Adam W, Ambrogi F, Bergauer T, Dragicevic M, et al.

Phys Rev Lett, 2020 Aug 07;125(6):061801.
PMID: 32845700 DOI: 10.1103/PhysRevLett.125.061801

The first observation of the tt[over ¯]H process in a single Higgs boson decay channel with the full reconstruction of the final state (H→γγ) is presented, with a significance of 6.6 standard deviations (σ). The CP structure of Higgs boson couplings to fermions is measured, resulting in an exclusion of the pure CP-odd structure of the top Yukawa coupling at 3.2σ. The measurements are based on a sample of proton-proton collisions at a center-of-mass energy sqrt[s]=13 TeV collected by the CMS detector at the LHC, corresponding to an integrated luminosity of 137 fb^{-1}. The cross section times branching fraction of the tt[over ¯]H process is measured to be σ_{tt[over ¯]H}B_{γγ}=1.56_{-0.32}^{+0.34} fb, which is compatible with the standard model prediction of 1.13_{-0.11}^{+0.08} fb. The fractional contribution of the CP-odd component is measured to be f_{CP}^{Htt}=0.00±0.33.

MeSH terms: Data Collection; Protons; United States; Physical Phenomena
Fulltext An enhanced dynamic transmission opportunity scheme to support varying traffic load over wireless campus networks

May Z, Alam MK, Husain K, Hasan MK

PLoS One, 2020;15(8):e0238073.
PMID: 32845901 DOI: 10.1371/journal.pone.0238073

Transmission opportunity (TXOP) is a key factor to enable efficient channel bandwidth utilization over wireless campus networks (WCN) for interactive multimedia (IMM) applications. It facilitates in resource allocation for the similar categories of multiple packets transmission until the allocated time is expired. The static TXOP limits are defined for various categories of IMM traffics in the IEEE802.11e standard. Due to the variation of traffic load in WCN, the static TXOP limits are not sufficient enough to guarantee the quality of service (QoS) for IMM traffic flows. In order to address this issue, several existing works allocate the TXOP limits dynamically to ensure QoS for IMM traffics based on the current associated queue size and pre-setting threshold values. However, existing works do not take into account all the medium access control (MAC) overheads while estimating the current queue size which in turn is required for dynamic TXOP limits allocation. Hence, not considering MAC overhead appropriately results in inaccurate queue size estimation, thereby leading to inappropriate allocation of dynamic TXOP limits. In this article, an enhanced dynamic TXOP (EDTXOP) scheme is proposed that takes into account all the MAC overheads while estimating current queue size, thereby allocating appropriate dynamic TXOP limits within the pre-setting threshold values. In addition, the article presents an analytical estimation of the EDTXOP scheme to compute the dynamic TXOP limits for the current high priority traffic queues. Simulation results were carried out by varying traffic load in terms of packet size and packet arrival rate. The results show that the proposed EDTXOP scheme achieves the overall performance gains in the range of 4.41%-8.16%, 8.72%-11.15%, 14.43%-32% and 26.21%-50.85% for throughput, PDR, average ETE delay and average jitter, respectively when compared to the existing work. Hence, offering a better TXOP limit allocation solution than the rest.

MeSH terms: Computers; Software; Multimedia; Resource Allocation
Renewable energy and environmental quality: A second-generation panel evidence from the Sub Saharan Africa (SSA) countries

Salahuddin M, Habib MA, Al-Mulali U, Ozturk I, Marshall M, Ali MI

Environ Res, 2020 12;191:110094.
PMID: 32846170 DOI: 10.1016/j.envres.2020.110094

This study employs dynamic panel data for 34 Sub Saharan Africa (SSA) countries for the period 1984-2016 to estimate the effects of renewable energy on environmental quality measured by three indicators, namely, per capita CO2 emissions, energy intensity (EI) and Aggregate National Savings (ANS). The study leveraged a battery of second-generation econometric tests and estimation and causality methods to obtain the coefficients between the regressed and the regressors. Results reveal that use of renewable energy reduces CO2 emissions and energy intensity while it enhances ANS. Economic growth still seems to be expensive for the region as it stimulates CO2 emissions. However, it has a positive effect on ANS. As expected, fossil fuels exacerbate CO2 emissions and energy intensity. FDI is found to be detrimental for the environment of SSA region with its positive significant coefficient on CO2 emissions. Financial development is reported to reduce CO2 emissions. Some causal links between variables are also noted.

MeSH terms: Family Characteristics; Africa South of the Sahara; Economic Development; Renewable Energy*

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