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Enhanced Mechanical and Thermal Properties of Modified Oil Palm Fiber-Reinforced Polypropylene Composite via Multi-Objective Optimization of In Situ Silica Sol-Gel Synthesis

Mat Rozi N, Hamid HA, Hossain MS, Khalil NA, Ahmad Yahaya AN, Syimir Fizal AN, et al.

Polymers (Basel), 2021 Sep 29;13(19).
PMID: 34641152 DOI: 10.3390/polym13193338

A multi-objective optimization of in situ sol-gel process was conducted in preparing oil palm fiber-reinforced polypropylene (OPF-PP) composite for an enhancement of mechanical and thermal properties. Tetraethyl orthosilicate (TEOS) and butylamine were used as precursors and catalysts for the sol-gel process. The face-centered central composite design (FCCD) experiments coupled with response surface methodology (RSM) has been utilized to optimize in situ silica sol-gel process. The optimization process showed that the drying time after the in-situ silica sol-gel process was the most influential factor on silica content, while the molar ratio of TEOS to water gave the most significant effect on silica residue. The maximum silica content of 34.1% and the silica residue of 35.9% were achieved under optimum conditions of 21.3 h soaking time, 50 min drying time, pH value of 9.26, and 1:4 molar ratio of TEOS to water. The untreated oil palm fiber (OPF) and silica sol-gel modified OPF (SiO2-OPF) were used as the reinforcing fibers, with PP as a matrix and maleic anhydride grafted polypropylene (MAgPP) as a compatibilizer for the fiber-reinforced PP matrix (SiO2-OPF-PP-MAgPP) composites preparation. The mechanical and thermal properties of OPF-PP, SiO2-OPF-PP, SiO2-OPF-PP-MAgPP composites, and pure PP were determined. It was found that the OPF-S-PP-MAgPP composite had the highest toughness and stiffness with values of tensile strength, Young's modulus, and elongation at break of 30.9 MPa, 881.8 MPa, and 15.1%, respectively. The thermal properties analyses revealed that the OPF-S-PP-MAgPP exhibited the highest thermally stable inflection point at 477 °C as compared to pure PP and other composites formulations. The finding of the present study showed that the SiO2-OPF had the potential to use as a reinforcing agent to enhance the thermal-mechanical properties of the composites.
First record of Batrachochytrium dendrobatidis infecting four frog families from Peninsular Malaysia

Savage AE, Grismer LL, Anuar S, Onn CK, Grismer JL, Quah E, et al.

Ecohealth, 2011 Mar;8(1):121-8.
PMID: 21541819 DOI: 10.1007/s10393-011-0685-y

The fungal pathogen Batrachochytrium dendrobatidis (Bd) infects amphibians on every continent where they occur and is linked to the decline of over 200 amphibian species worldwide. At present, only three published Bd surveys exist for mainland Asia, and Bd has been detected in South Korea alone. In this article, we report the first survey for Bd in Peninsular Malaysia. We swabbed 127 individuals from the six amphibian families that occur on Peninsular Malaysia, including two orders, 27 genera, and 47 species. We detected Bd on 10 out of 127 individuals from four of five states and five of 11 localities, placing the 95% confidence interval for overall prevalence at 4-14%. We detected no variation in Bd prevalence among regions, elevations, or taxonomic groups. The infection intensity ranged from 1 to 157,000 genome equivalents. The presence of Bd infections in native species without clinical signs of disease suggests that Bd may be endemic to the region. Alternately, Bd may have been introduced from non-native amphibians because of the substantial amphibian food trade in Peninsular Malaysia. Under both scenarios, management efforts should be implemented to limit the spread of non-native Bd and protect the tremendous amphibian diversity in Peninsular Malaysia.
Fulltext Split-Course Radiotherapy in Stage IV Head & Neck Cancer

Biswal BM, Ruzman N, Ahmad NM, Zakaria A

Malays J Med Sci, 2000 Jan;7(1):54-9.
PMID: 22844216 MyJurnal

Short course hypo-fractionated radiotherapy is a standard regime for the palliation of stage IV head and neck cancers. However few patients respond favorably and require further radiotherapy in curative intent. We have used split-course radiotherapy technique to find out this conversion rate from palliative to curative intent. This was a prospective study conducted from November 1998 to October 1999; twenty-six (26) patients with stage IV head & neck cancers were treated with a hypofractionated regime of radiotherapy. A tumor dose of 30 Gy in 10 fractions [time dose fraction (TDF) 62] over 2 weeks was delivered using a 6 MV linear accelerator. A conventional 2 field or 3 field technique was used. Patients were assessed for the regression of tumor on fifth day, tenth day of radiotherapy and 4 weeks after the completion of radiotherapy. Patients showing complete response and good partial response were allowed to receive further radiotherapy of 30 Gy in 15 fractions [TDF 49]. There were 21 males and 5 females in the study with a median age of 44 years (range 19-77 years). All patients completed the initial regime. Complete responses were observed among 14 patients (54%); partial response in 6 patients (23%), and no response was seen among 6 patients (23%). Sixteen patients (61%) were suitable for radical radiotherapy after phase-I course of the above schedule. Seventeen patients (65%) showed an improvement in the general well being with a better quality of life. One year actuarial survival was (76%), with a median survival time of 12 months. Split-course technique is a useful radiotherapy treatment in stage IV head and neck cancers to distinguish between the subset of patients who would require curative treatment and who would not.
Fulltext Lightning performance analysis of a rooftop grid-connected solar photovoltaic without external lightning protection system

Nasir MSM, Ab-Kadir MZA, Radzi MAM, Izadi M, Ahmad NI, Zaini NH

PLoS One, 2019;14(7):e0219326.
PMID: 31295278 DOI: 10.1371/journal.pone.0219326

The Sustainable Energy Development Authority of Malaysia (SEDA) regularly receives complaints about damaged components and distribution boards of PV systems due to lightning strikes. Permanent and momentary interruptions of distribution circuits may also occur from the disturbance. In this paper, a solar PV Rooftop system (3.91 kWp) provided by SEDA was modelled in the PSCAD/EMTDC. The Heidler function was used as a lightning current waveform model to analyse the transient current and voltage at two different points susceptible to the influence of lightning events such as different lightning current wave shape, standard lightning current and non-standard lightning current. This study examines the effect on the system components when lightning directly strikes at two different points of the installation. The two points lie between the inverter and the solar PV array and between inverter and grid. Exceptionally high current and voltage due to the direct lightning strike on a certain point of a PV Rooftop system was also studied. The result of this case study is observed with and without the inclusion of surge protective devices (SPDs). The parameters used were 31 kA of peak current, 10 metres cable length and lightning impulse current wave shape of 8/20μs. The high current and voltage at P1 striking point were 31 kA and 2397 kV, respectively. As for the AC part, the current and voltage values were found to be 5.97 kA and 5392 kV, respectively.Therefore, SPDs with suitable rating provided by SEDA were deployed. Results showed that high transient current voltage is expected to clamp sharply at the values of 1.915 kV and 0 A at the P1 striking point. As for the AC part, the current and voltage values were found to be 0 kA and 0.751 V, respectively. Varying lightning impulse current wave shapes at striking point P2 showed that the highest voltage was obtained at waveshape 10/350 μs at 11277 kV followed by wave shapes of 2/70 μs, 8/20 μs and 0.7/6 μs. The high value of transient voltage was clamped at a lower level of 2.029 kV. Different lightning amplitudes were also applied, ranging from 2-200 kA selected based on the CIGRE distribution. It showed that the current and voltage at P1 and P2 were directly proportional. Therefore, the SPD will be designed at an acceptable rating and proper position of SPD installation at solar PV Rooftop will be proposed. The results obtained in this study can then be utilised to appropriately assign a SPD to protect the PV systems that are connected to the grid. Installing SPDs without considering the needs of lightning protection zones would expose the expensive equipment to potential damage even though the proper energy coordination of SPDs is in place. As such, the simulation results provide a basis for controlling the impacts of direct lightning strikes on electrical equipment and power grids and thus justify SPD coordination to ensure the reliability of the system.
Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?: A Systematic Review and Meta-analysis

Nattabi HA, Sharif NM, Yahya N, Ahmad R, Mohamad M, Zaki FM, et al.

Acad Radiol, 2017 Oct 18.
PMID: 29054676 DOI: 10.1016/j.acra.2017.09.002

RATIONALE AND OBJECTIVE: This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules.
METHODS: PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve.
RESULTS: After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively.
CONCLUSION: Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.
Comparative efficacy trials with alcohol added d-phenothrin formulations against Aedes aegypti under open-field condition

Megat Nabil Mohsin S, Ahmad N, Yusof YA

Pest Manag Sci, 2023 Oct;79(10):4094-4099.
PMID: 37300851 DOI: 10.1002/ps.7610

BACKGROUND: Evaporation inhibition of water-based space spray insecticides is necessary to prevent the drifting away of fog droplets and the release of insecticidal actives and to prolong suspension time. To address this problem, hygroscopic alcohols, namely propylene glycol and glycerol, were included as adjuvants in water-based d-phenothrin formulations. The performances of glycerol-added formulation (D1) and propylene glycol-added formulation (D2) in terms of droplet size and efficacy against larvae, pupae and adult Aedes aegypti in an open-field environment were examined and compared to the performance of a formulation without adjuvant (negative control).
RESULTS: No significant difference in droplet size was observed between the formulations and fogging methods. The efficacy of cold fogs was significantly higher than thermal fogs for all formulations. D2 was found to be most effective against adult Ae. aegypti, followed by D1 and the negative control. D1 and D2 provided complete knockdown and mortality in adult Ae. aegypti at 10 and 25 m for cold and thermal fogging, respectively. However, all d-phenothrin formulations possessed minimal efficacy on immature Ae. aegypti.
CONCLUSION: The incorporation of non-toxic alcohols as adjuvants in water-based space spray insecticides increased efficacy against adult Ae. aegypti, a major vector for dengue. Propylene glycol was discovered to induce higher adulticidal efficacy than glycerol. © 2023 Society of Chemical Industry.
Dental students' perceptions on the contribution and impact role of a clinical teacher

Shoaib LA, Safii SH, Naimie Z, Ahmad NA, Sukumaran P, Yunus RM

Eur J Dent Educ, 2018 Feb;22(1):e26-e34.
PMID: 27995730 DOI: 10.1111/eje.12252

OBJECTIVES: This study was conducted in University of Malaya to evaluate student perceptions on the contribution and role of an effective clinical teacher based on the cognitive apprenticeship model in clinical practice.
METHODS: Self-administered questionnaires were distributed to 233 undergraduate dental students involved with clinical teaching. This modified and validated questionnaire focusing on students' learning environment was used in order to gain relevant information related to dental clinical teaching. Six domains with different criteria applicable to clinical teaching in dentistry were selected consisting of modelling (four criteria), coaching (four criteria), scaffolding (four criteria), articulation (four criteria), reflection (two criteria) and general learning environment (six criteria). Data analyses were performed using IBM SPSS Statistics 20.
RESULTS: Majority of the students expressed positive perceptions on their clinical learning experience towards the clinical teachers in the Faculty of Dentistry, University of Malaya, in all criteria of the domains. Few negative feedbacks concerning the general learning environment were reported.
CONCLUSION: Further improvement in the delivery of clinical teaching preferably by using wide variety of teaching-learning activities can be taken into account through students' feedback on their learning experience.
A new species of Leptolalax (Amphibia, Anura, Megophryidae) from Peninsular Malaysia

Matsui M, Belabut DM, Ahmad N, Yong HS

Zoolog Sci, 2009 Mar;26(3):243-7.
PMID: 19341347 DOI: 10.2108/zsj.26.243

A new megophryid species, Leptolalax kecil, is described from the Cameron Highlands of Peninsular Malaysia on the basis of acoustic and morphological characteristics. It has an advertisement call dissimilar to that of other, congeneric species, and is the smallest of the known Leptolalax. It is similar to L. pluvialis from Vietnam in small body size, but differs from it in ventral color, and in the size and color of the pectoral gland. The distributional pattern of the new species Is discussed.
Toxicity assessment of reduced graphene oxide and titanium dioxide nanomaterials on gram-positive and gram-negative bacteria under normal laboratory lighting condition

Ahmad NS, Abdullah N, Yasin FM

Toxicol Rep, 2020;7:693-699.
PMID: 32528857 DOI: 10.1016/j.toxrep.2020.04.015

Toxicity effect of reduced graphene oxide (rGO) and titanium dioxide (TiO2) nanomaterials (NMs) on Gram-positive (Bacillus subtilis) and Gram-negative (Escherichia coli) bacteria was assessed. For both strains, study demonstrated that the toxicity was time and concentration dependent which led to reduction in growth rate and cell death. Upon NMs exposure, an instantaneous cell death in E. coli culture was observed. This is in contrast with B. subtilis, in which the culture growth remained in the log phase; however their growth rate constant,

μ
g

was reduced by ∼70%. The discrepancy between E. coli and B. subtilis was due to strain-specific response upon contact with NMs. TEM, SEM and EDX analysis revealed direct physical surface-surface interaction, as evidence from the adherence of NMs on the cell surface.
Fulltext Frequency, management and impact of adverse events on treatment outcomes in patients with multidrug resistant tuberculosis in Balochistan, Pakistan

Rafique S, Ahmad N, Khan S, Khan A, Atif M, Wahid A, et al.

J Pharm Policy Pract, 2024;17(1):2332878.
PMID: 38572376 DOI: 10.1080/20523211.2024.2332878

BACKGROUND: Early detection, monitoring, and managing adverse events (AEs) are crucial in optimising treatment for multidrug-resistant tuberculosis (MDR-TB) patients.
OBJECTIVES: To investigate the incidence, factors, management, and impact of AEs on treatment outcomes in MDR-TB patients.
METHODS: This study reviewed the medical records of 275 MDR-TB patients at Fatimah Jinnah Institute of Chest Diseases in Quetta, Pakistan. Patient information was collected using a designed data collection form. Mann-Whitney U and Kruskal-Wallis tests examined the difference in AEs occurrences based on patients' characteristics. Multiple binary logistic regression identified factors associated with unsuccessful outcomes, with statistical significance set at a p-value 60 years(OR = 23.481), baseline body weight of 31-60 kg(OR = 0.180), urban residence(OR = 0.296), and experiencing ototoxicity (OR = 0.258) and hypothyroidism (OR = 0.136) were significantly associated with unsuccessful treatment outcomes.
CONCLUSION: AEs were highly prevalent but did not negatively impact treatment outcomes. Patients at higher risk of developing AEs and unsuccessful outcomes should receive special attention for its early management.
DETECTION OF BURKHOLDERIA PSEUDOMALLEI FROM POST-FLOOD SOIL SAMPLES IN KELANTAN, MALAYSIA

Shaharudin R, Ahmad N, Kamaluddin MA, Veloo Y

Southeast Asian J. Trop. Med. Public Health, 2016 Sep;47(5):951-6.
PMID: 29620800

Burkholderia pseudomallei is an important causative organism of fatal community bacteremia especially in Southeast Asia and northern Australia. Outbreaks of melioidosis have been reported post-floods and -typhoons. A cross sectional study was conducted in January 2015, following a major flood in Kelantan, Malaysia to detect presence of B. pseudomallei from soil. A total of 89 soil samples were cultured for B. pseudomallei on Ashdown agar. Putative colonies underwent further staining and biochemical testing prior to confirmation by PCR. Rate of detection was 1%, although low, it nevertheless indicated a risk for melioidosis among flood victims in Kelantan. Flood affected individuals should be made aware of symptoms of melioidosis and healthcare providers must have a high index of suspicion of patients presenting with fever. Such subjects should be screened for the possibility of melioidosis and given prompt treatment to avoid preventable death.
Fulltext Knowledge and preventive behaviour among pregnant women with latent toxoplasmosis in Malaysia

Ahmad N., Osman, E., Abdul Ghani, N.A., Leong, W.Y., Arzaee, M.Z., Seow, Y.Y., et al.

Medicine & Health, 2020;15(2):108-123.
MyJurnal

Toksoplasmosis pendam dapat menyebabkan pelbagai gangguan hormon dan tingkah laku dalam hos terjangkit. Kami berhasrat untuk mengkaji sero-prevalens Toxoplasma gondii (T. gondii) pendam serta hubungan antara jangkitan dengan pengetahuan dan tingkah laku dalam kalangan 400 ibu hamil. Sampel plasma diuji untuk kehadiran antibodi IgG T. gondii dan soal selidik berstruktur digunakan untuk merekodkan ciri-ciri sosio-demografi responden, maklumat umum dan pengetahuan mengenai faktor risiko, gejala, masa jangkitan, pengetahuan pencegahan serta tingkah laku pencegahan toksoplasmosis. Sero-prevalensi toksoplasmosis pendam dalam wanita hamil adalah 31.8%. Kajian menunjukkan, 69.5% daripada mereka mempunyai kurang pengetahuan mengenai toksoplasmosis. Walau bagaimanapun, majoritinya (99.8%) mengamalkan tingkah laku pencegahan. Analisis regresi logistik berganda menunjukkan wanita hamil dengan tahap pendidikan rendah mempunyai hampir dua kali lebih risiko (nisbah ods terlaras: 1.91, 95% SK 1.18, 3.10; p = 0.008) untuk T. gondii IgG seropositif. Wanita hamil yang mempunyai sejarah perubatan lalu mempunyai dua kali lebih kemungkinan (nisbah ods terlaras: 2.32, 95% SK 1.32, 4.06; p = 0.003) untuk T. gondii IgG seropositif. Selain itu, wanita yang tidak pasti mengenai mod penyebaran penyakit melalui pemindahan darah mempunyai empat kali lebih ods (nisbah ods terlaras: 3.93, 95% SK 1.54, 10.01; p = 0.004) untuk sero-prevalens kronik toksoplasmosis. Wanita yang tidak pasti mengenai keperluan menghindari kucing liar mempunyai nisbah ods terlaras: 0.42 (95% SK 0.24, 0.71, p = 0.001) untuk sero-prevalens kronik toksoplasmosis. Penterjemahan pengetahuan tentang toksoplasmosis kepada amalan tingkah laku pencegahan melalui program pendidikan kesihatan adalah penting untuk mengurangkan risiko penularan penyakit ini dalam kalangan wanita hamil.
Daunorubicin oral bioavailability enhancement by surface coated natural biodegradable macromolecule chitosan based polymeric nanoparticles

Ahmad N, Ahmad R, Alam MA, Ahmad FJ, Amir M, Pottoo FH, et al.

Int J Biol Macromol, 2019 May 01;128:825-838.
PMID: 30690115 DOI: 10.1016/j.ijbiomac.2019.01.142

BACKGROUND: Daunorubicin hydrochloride (DAUN·HCl), due to low oral bioavailability poses the hindrance to be marketed as an oral formulation.
AIM OF THE STUDY: To develop a natural biodegradable macromolecule i.e. Chitosan (CS)-coated-DAUN-PLGA-poly(lactic-co-glycolic acid)-Nanoparticles (NPs) with an aim to improve oral-DAUN bioavailability and to develop as well as validate UHPLC-MS/MS (ESI/Q-TOF) method for plasma quantification and pharmacokinetic analysis (PK) of DAUN.
RESULTS: A particle size (198.3 ± 9.21 nm), drug content (47.06 ± 1.16 mg/mg) and zeta potential (11.3 ± 0.98 mV), consisting of smooth and spherical shape was observed for developed formulation. Cytotoxicity studies for CS-DAUN-PLGA-NPs revealed; a comparative superiority over free DAUN-S (i.v.) in human breast adenocarcinoma cell lines (MCF-7) and a higher permeability i.e. 3.89 folds across rat ileum, as compared to DAUN-PLGA-NPs (p 
Fulltext Characterization of Shigella sonnei in Malaysia, an increasingly prevalent etiologic agent of local shigellosis cases

Koh XP, Chiou CS, Ajam N, Watanabe H, Ahmad N, Thong KL

BMC Infect Dis, 2012;12:122.
PMID: 22606962 DOI: 10.1186/1471-2334-12-122

Shigellosis is a major public health concern worldwide, especially in developing countries. It is an acute intestinal infection caused by bacteria of the genus Shigella, with a minimum infective dose as low as 10-100 bacterial cells. Increasing prevalence of Shigella sonnei as the etiologic agent of shigellosis in Malaysia has been reported. As there is limited information on the genetic background of S. sonnei in Malaysia, this study aimed to characterize Malaysian S. sonnei and to evaluate the prospect of using multilocus variable-number tandem-repeat (VNTR) analysis (MLVA) for subtyping of local S. sonnei.
Fulltext The discrimination of d-tartrate positive and d-tartrate negative S. enterica subsp. enterica serovar Paratyphi B isolated in Malaysia by phenotypic and genotypic methods

Ahmad N, Hoon ST, Ghani MK, Tee KY

Malays J Pathol, 2012 Jun;34(1):35-9.
PMID: 22870596 MyJurnal

Serotyping is not sufficient to differentiate between Salmonella species that cause paratyphoid fever from the strains that cause milder gastroenteritis as these organisms share the same serotype Salmonella Paratyphi B (S. Paratyphi B). Strains causing paratyphoid fever do not ferment d-tartrate and this key feature was used in this study to determine the prevalence of these strains among the collection of S. Paratyphi B strains isolated from patients in Malaysia. A total of 105 isolates of S. Paratyphi B were discriminated into d-tartrate positive (dT+) and d-tartrate negative (dT) variants by two lead acetate test protocols and multiplex PCR. The lead acetate test protocol 1 differed from protocol 2 by a lower inoculum size and different incubation conditions while the multiplex PCR utilized 2 sets of primers targeting the ATG start codon of the gene STM3356. Lead acetate protocol 1 discriminated 97.1% of the isolates as S. Paratyphi B dT+ and 2.9% as dT while test protocol 2 discriminated all the isolates as S. Paratyphi B dT+. The multiplex PCR test identified all 105 isolates as S. Paratyphi B dT+ strains. The concordance of the lead acetate test relative to that of multiplex PCR was 97.7% and 100% for protocol 1 and 2 respectively. This study showed that S. Paratyphi B dT+ is a common causative agent of gastroenteritis in Malaysia while paratyphoid fever appears to be relatively uncommon. Multiplex PCR was shown to be a simpler, more rapid and reliable method to discriminate S. Paratyphi B than the phenotypic lead acetate test.
Fulltext The Impact of Meteorological Factors on Communicable Disease Incidence and Its Projection: A Systematic Review

Baharom M, Ahmad N, Hod R, Arsad FS, Tangang F

Int J Environ Res Public Health, 2021 10 22;18(21).
PMID: 34769638 DOI: 10.3390/ijerph182111117

BACKGROUND: Climate change poses a real challenge and has contributed to causing the emergence and re-emergence of many communicable diseases of public health importance. Here, we reviewed scientific studies on the relationship between meteorological factors and the occurrence of dengue, malaria, cholera, and leptospirosis, and synthesized the key findings on communicable disease projection in the event of global warming.
METHOD: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow checklist. Four databases (Web of Science, Ovid MEDLINE, Scopus, EBSCOhost) were searched for articles published from 2005 to 2020. The eligible articles were evaluated using a modified scale of a checklist designed for assessing the quality of ecological studies.
RESULTS: A total of 38 studies were included in the review. Precipitation and temperature were most frequently associated with the selected climate-sensitive communicable diseases. A climate change scenario simulation projected that dengue, malaria, and cholera incidence would increase based on regional climate responses.
CONCLUSION: Precipitation and temperature are important meteorological factors that influence the incidence of climate-sensitive communicable diseases. Future studies need to consider more determinants affecting precipitation and temperature fluctuations for better simulation and prediction of the incidence of climate-sensitive communicable diseases.
Fulltext The Impact of Heatwaves on Mortality and Morbidity and the Associated Vulnerability Factors: A Systematic Review

Arsad FS, Hod R, Ahmad N, Ismail R, Mohamed N, Baharom M, et al.

Int J Environ Res Public Health, 2022 Dec 06;19(23).
PMID: 36498428 DOI: 10.3390/ijerph192316356

BACKGROUND: This study aims to investigate the current impacts of extreme temperature and heatwaves on human health in terms of both mortality and morbidity. This systematic review analyzed the impact of heatwaves on mortality, morbidity, and the associated vulnerability factors, focusing on the sensitivity component.
METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. Four databases (Scopus, Web of Science, EBSCOhost, PubMed) were searched for articles published from 2012 to 2022. Those eligible were evaluated using the Navigation Guide Systematic Review framework.
RESULTS: A total of 32 articles were included in the systematic review. Heatwave events increased mortality and morbidity incidence. Sociodemographic (elderly, children, male, female, low socioeconomic, low education), medical conditions (cardiopulmonary diseases, renal disease, diabetes, mental disease), and rural areas were crucial vulnerability factors.
CONCLUSIONS: While mortality and morbidity are critical aspects for measuring the impact of heatwaves on human health, the sensitivity in the context of sociodemographic, medical conditions, and locality posed a higher vulnerability to certain groups. Therefore, further research on climate change and health impacts on vulnerability may help stakeholders strategize effective plans to reduce the effect of heatwaves.
Fulltext Correlation of iatrogenic mild hyperkalaemia and bradyarrhythmia: a problem of polypharmacy in elderly

Ahmad, N. H., Tan, T. L.

Medicine & Health, 2017;12(2):329-334.
MyJurnal

Mild hyperkalaemia does not typically cause cardiac symptoms. However, for an elderly patient on atrio-ventricular (AV) nodal blocker, even mild hyperkalaemia may result in disastrous outcome. We report a case of persistent bradyarrythmia caused by iatrogenic hyperkalaemia in a patient who had concomitant use of AV nodal medication. An 81-year-old lady with multiple comorbidities and a long list of medications presented with symptomatic bradyarrhythmia. She, in fact, had two AV nodal blockers in her prescription, a beta-blocker and amiodarone. Her potassium level was found to be mildly elevated due to acute renal failure. She remained bradycardic despite initial treatment and was subsequently dependant on intravenous isoproterenol until her renal function improved. This case highlights the different threshold for manifestation of hyperkalaemic symptoms in a growing group of patients: elderly patients with multiple comorbidities and polypharmacy.
Keywords: bradyarrythmia, bradycardia, elderly, hyperkalaemia, polypharmacy
Fulltext Head and neck cancer: possible causes for delay in diagnosis and treatment

Lee SC, Tang IP, Avatar SP, Ahmad N, Selva KS, Tay KK, et al.

Med J Malaysia, 2011 Jun;66(2):101-4.
PMID: 22106686 MyJurnal

To explore the possible causes for delay in diagnosis and treatment of head and neck cancer at Sarawak General Hospital (SGH).
Fulltext Estimating the population health and economic impacts of introducing a pneumococcal conjugate vaccine in Malaysia- an economic evaluation

Shafie AA, Ahmad N, Naidoo J, Foo CY, Wong C, Pugh S, et al.

Hum Vaccin Immunother, 2020 07 02;16(7):1719-1727.
PMID: 31951782 DOI: 10.1080/21645515.2019.1701911

Pneumococcal disease is a potentially fatal bacterial infection that is vaccine-preventable. Malaysia has yet to adopt a pneumococcal conjugate vaccine (PCV) into its national immunization program (NIP). In 2016, pneumonia was the 3rd leading cause of death in children under five in Malaysia, accounting for 3.8% of under-five deaths. Introducing a pneumococcal conjugate vaccine (PCV) is an effective strategy to reduce the disease burden. This study used a decision-analytic model to assess the potential impacts of introducing the available PCVs (13-valent and 10-valent) in Malaysia. Epidemiological and costs inputs were sourced from published literature. For each vaccination program, health outcomes and associated healthcare costs were estimated. The scenarios of initiating PCV13 vs. PCV10 and the status quo (no pneumococcal vaccine) were compared. Serotype trends of Finland and the U.K. were used to model the clinical impacts of PCV10 and PCV13 respectively. The base-case analysis used a societal perspective over a 5-year time horizon. Compared with PCV10, PCV13 was projected to avert an additional 190,628 cases of pneumococcal disease and 1126 cases of death. The acquisition of PCV13 was estimated to cost an incremental US$89,904,777, offset by a cost reduction of -US$250,219,914 on pneumococcal disease-related medical care and lost productivity. PCV13 demonstrated a higher cost-saving potential over PCV10. Compared with no vaccination, PCV13 was estimated as cost-saving. Results were robust across a series of sensitivity analyses. The introduction of PCV13 in a NIP was estimated to reduce a significant burden of disease and to be a cost-saving for the Malaysian health system.

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