Displaying publications 1 - 20 of 66 in total

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  1. Khan MSJ, Mohd Sidek L, Kamal T, Khan SB, Basri H, Zawawi MH, et al.
    J Environ Manage, 2024 Feb 19;354:120228.
    PMID: 38377746 DOI: 10.1016/j.jenvman.2024.120228
    The effective reduction of hazardous organic pollutants in wastewater is a pressing global concern, necessitating the development of advanced treatment technologies. Pollutants such as nitrophenols and dyes, which pose significant risks to both human and aquatic health, making their reduction particularly crucial. Despite the existence of various methods to eliminate these pollutants, they are not without limitations. The utilization of nanomaterials as catalysts for chemical reduction exhibits a promising alternative owing to their distinguished catalytic activity and substantial surface area. For catalytically reducing the pollutants NaBH4 has been utilized as a useful source for it because it reduces the pollutants quiet efficiently and it also releases hydrogen gas as well which can be used as a source of energy. This paper provides a comprehensive review of recent research on different types of nanomaterials that function as catalysts to reduce organic pollutants and also generating hydrogen from NaBH4 methanolysis while also evaluating the positive and negative aspects of nanocatalyst. Additionally, this paper examines the features effecting the process and the mechanism of catalysis. The comparison of different catalysts is based on size of catalyst, reaction time, rate of reaction, hydrogen generation rate, activation energy, and durability. The information obtained from this paper can be used to steer the development of new catalysts for reducing organic pollutants and generation hydrogen by NaBH4 methanolysis.
  2. Khan MSJ, Sidek LM, Kamal T, Asiri AM, Khan SB, Basri H, et al.
    Int J Biol Macromol, 2024 Feb;257(Pt 1):128544.
    PMID: 38061525 DOI: 10.1016/j.ijbiomac.2023.128544
    This work reports silver nanoparticles (AgNPs) supported on biopolymer carboxymethyl cellulose beads (Ag-CMC) serves as an efficient catalyst in the reduction process of p-nitrophenol (p-NP) and methyl orange (MO). For Ag-CMC synthesis, first CMC beads were prepared by crosslinking the CMC solution in aluminium nitrate solution and then the CMC beads were introduced into AgNO3 solution to adsorb Ag ions. Field emission scanning electron microscopy (FE-SEM) analysis suggests the uniform distribution of Ag nanoparticles on the CMC beads. The X-ray photoelectron spectroscopy (XPS) and X-ray diffraction (XRD) analysis revealed the metallic and fcc planes of AgNPs, respectively, in the Ag-CMC catalyst. The Ag-CMC catalyst exhibits remarkable reduction activity for the p-NP and MO dyes with the highest rate constant (kapp) of a chemical reaction is 0.519 and 0.697 min-1, respectively. Comparative reduction studies of Ag-CMC with CMC, Fe-CMC and Co-CMC disclosed that Ag-CMC containing AgNPs is an important factore in reducing the organic pollutants like p-NP and MO dyes. During the recyclability tests, the Ag-CMC also maintained high reduction activity, which suggests that CMC protects the AgNPs from leaching during dye reduction reactions.
  3. Jaganathan N, Mohamed MH, Md Pauzi AL, Mahayidin H, Hanapai AF, Wan Sulaiman WA, et al.
    Front Neurol, 2024;15:1339039.
    PMID: 38497038 DOI: 10.3389/fneur.2024.1339039
    Accurate and timely diagnosis of posterior circulation stroke in patients with acute dizziness is a challenge that can lead to misdiagnosis and significant harm. The present review sought to identify and describe published research on the clinical application of vHIT in posterior circulation stroke. vHIT, a portable device, has gained prominence in evaluating peripheral vestibular disorders and offers potential applications in diagnosing neurological disorders, particularly posterior circulation stroke. Several studies have shown that vHIT can differentiate between stroke and vestibular neuritis based on VOR gain values, with high sensitivity and specificity. The manuscript also discusses vHIT's performance in differentiating between types of posterior circulation stroke, such as PICA, AICA, and SCA strokes. While vHIT has demonstrated promise, the review emphasizes the need for further research to validate its use as a tool to rule out stroke in acute dizziness patients in the emergency department. In conclusion, the manuscript underscores the potential of vHIT as a valuable addition to the diagnostic arsenal for acute dizziness, particularly in the context of posterior circulation stroke. It calls for further research and wider adoption of vHIT in clinical settings to improve patient care and reduce unnecessary costs associated with misdiagnoses.
  4. Badawi AH, Mohamad NA, Stanslas J, Kirby BP, Neela VK, Ramasamy R, et al.
    Curr Neuropharmacol, 2023 Dec 08.
    PMID: 38073104 DOI: 10.2174/1570159X22666231207114346
    The blood-brain barrier (BBB) is a complex, dynamic, and adaptable barrier between the peripheral blood system and the central nervous system. While this barrier protects the brain and spinal cord from inflammation and infection, it prevents most drugs from reaching the brain tissue. With the expanding interest in the pathophysiology of BBB, the development of in vitro BBB models has dramatically evolved. However, due to the lack of a standard model, a range of experimental protocols, BBB-phenotype markers, and permeability flux markers was utilized to construct in vitro BBB models. Several neuroinfectious diseases are associated with BBB dysfunction. To conduct neuroinfectious disease research effectively, there stems a need to design representative in vitro human BBB models that mimic the BBB's functional and molecular properties. The highest necessity is for an in vitro standardised BBB model that accurately represents all the complexities of an intact brain barrier. Thus, this in-depth review aims to describe the optimization and validation parameters for building BBB models and to discuss previous research on neuroinfectious diseases that have utilized in vitro BBB models. The findings in this review may serve as a basis for more efficient optimisation, validation, and maintenance of a structurally- and functionally intact BBB model, particularly for future studies on neuroinfectious diseases.
  5. Purwanti IF, Abdullah SRS, Hamzah A, Idris M, Basri H, Latif MT, et al.
    Heliyon, 2023 Nov;9(11):e21737.
    PMID: 38027659 DOI: 10.1016/j.heliyon.2023.e21737
    Phytoremediation is one of the green technologies that is friendly to nature, utilizes fewer chemicals, and exhibits good performance. In this study, phytoremediation was used to treat diesel-contaminated sand using a local aquatic plant species, Scirpus mucronatus, by analyzing the amount of total petroleum hydrocarbons (TPHs). Optimization of diesel removal was performed according to Response Surface Methodology (RSM) using Box-Behnken Design (BBD) under pilot-scale conditions. The quadratic model showed the best fit to describe the obtained data. Actual vs. predicted values from BBD showed a total of 9.1 % error for the concentration of TPH in sand and 0 % error for the concentration of TPH in plants. Maximum TPH removal of 42.3 ± 2.1 % was obtained under optimized conditions at a diesel initial concentration of 50 mg/kg, an aeration rate of 0.48 L/min, and a retention time of 72 days. The addition of two species of rhizobacteria (Bacillus subtilis and Bacillus licheniformis) at optimum conditions increased the TPH removal to 51.9 ± 2.6 %. The obtained model and optimum condition can be adopted to treat diesel-contaminated sand within the same TPH range (50-3000 mg/kg) in sand.
  6. Wong KY, Basri H, Wong YL, Wahab M, Haji Kipli NP, Niap I, et al.
    Asian Pac J Cancer Prev, 2023 Aug 01;24(8):2817-2822.
    PMID: 37642069 DOI: 10.31557/APJCP.2023.24.8.2817
    OBJECTIVES: This analysis provides an epidemiological update for nasopharyngeal carcinomas the state of Sarawak and an analysis of the trend over a 20 years period.

    METHOD: Data between 1996 to 2015 from a population-based cancer registry in Sarawak Malaysia was analyzed. Crude incidence rates and age-standardized rates (ASR) were calculated and compared between ethnic groups and locations (administrative division) and Joinpoint regression analysis was done to analyze trends.

    RESULT: A total of 3643 cases of NPC were recorded with male to female ratio of 2.5:1. Annualised age-standardized incidence rates able 2) for men is 13.2 cases per 100,000 population (95% CI: 12.6, 13.7) and for women is 5.3 cases per 100,000 population (95% CI: 5.0, 5.6). The highest incidence rates were reported among the Bidayuh population and it ranks among the highest in the world. Trend analysis noted an overall reduction of cases, with a significant decrease between 1996 and 2003 (annual percentage reduction of incidence by 3.9%). Analysis of individual ethnic groups also shows a general reduction with exception of Iban males showing an average 5.48 per cent case increase between 2009 to 2015, though not statistically significant.

    CONCLUSION: Comparing the incidences with other registries, the Bidayuh population in Sarawak remained among the highest in the world and warrants close attention for early screening and prevention strategies.

  7. Ibrahim A, Ghazali WSW, Misyail A, Najwa L, Khan AH, Amir WM, et al.
    BMC Neurol, 2023 Mar 22;23(1):117.
    PMID: 36949469 DOI: 10.1186/s12883-023-03170-1
    BACKGROUND: There is a growing body of evidence that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19 infection is associated with the development of autoimmune diseases. A recent systematic review reported that the new-onset autoimmune disorders during or after COVID-19 infection included inflammatory myopathies such as immune-mediated necrotizing myopathies.

    CASE PRESENTATION: We described a 60-year-old man diagnosed with COVID-19 infection and later presented with a two-week history of myalgia, progressive limb weakness, and dysphagia. He had a Creatinine Kinase (CK) level of more than 10,000 U/L, was strongly positive for anti-signal recognition particle (SRP) and anti-Ro52 antibody, and a muscle biopsy revealed a paucity-inflammation necrotizing myopathy with randomly distributed necrotic fibers, which was consistent with necrotizing autoimmune myositis (NAM). He responded well clinically and biochemically to intravenous immunoglobulin, steroids and immunosuppressant and he was able to resume to his baseline.

    CONCLUSION: SARS-CoV-2 may be associated with late-onset necrotizing myositis, mimicking autoimmune inflammatory myositis.

  8. Abdul Rashid AM, Md Noh MSF, Yusof Khan AHK, Loh WC, Baharin J, Ibrahim A, et al.
    BMC Neurol, 2023 Feb 15;23(1):72.
    PMID: 36792988 DOI: 10.1186/s12883-023-03102-z
    BACKGROUND AND AIMS: The corononavirus 2019 (COVID-19) pandemic resulted in modifications in the workflow and redistribution of human resources, causing challenges in setting up of an acute stroke service. We would like to share our preliminary outcome amid this pandemic, to determine if the implementation of COVID-19 standard operating procedures (SOPs) affected the delivery of our hyperacute stroke service.

    METHODS: We retrospectively analyzed one-year data from our stroke registry that began with the establishment of our hyperacute stroke service at Universiti Putra Malaysia Teaching Hospital from April 2020 until May 2021.

    RESULTS: Setting up acute stroke services during the pandemic with constrained manpower and implementation of COVID-19 SOPs, was challenging. There was a significant dip of stroke admission from April to June 2020 due to the Movement Control Order (MCO) implemented by the government to curb the spread of COVID-19. However, the numbers of stroke admission steadily rose approaching 2021, after the implementation of recovery MCO. We managed to treat 75 patients with hyperacute stroke interventions i.e. intravenous thrombolysis (IVT), mechanical thrombectomy (MT) or both. Despite implementing COVID-19 SOPs and using magnetic resonance imaging (MRI) as our first line acute stroke imaging modality, clinical outcomes in our cohort were encouraging; almost 40% of patients who underwent hyperacute stroke treatment had early neurological recovery (ENR), and only 33% of patients had early neurological stability (ENS). In addition, we were able to maintain our door-to-imaging (DTI) and door-to-needle (DTN) time in line with international recommendations.

    CONCLUSIONS: Our data reflects that COVID-19 SOPs did not deter successful delivery of hyperacute stroke services in our center. However, bigger and multi center studies are required to support our findings.

  9. Sohor NJ, Loh WC, Pang RY, Khan AH, Chia PK, Sulaiman WAW, et al.
    Neurol India, 2023;71(6):1260-1262.
    PMID: 38174472 DOI: 10.4103/0028-3886.391392
    Methanol toxicity remains as major problem in the medical field.[1],[2],[3] With its active metabolite, formic acid often leads to severe metabolic acidosis and to some extend brain damaged.[4],[5],[6] We are reporting a case of brain hemorrhage at the right external capsule and left basal ganglia with mass effect and obstructive hydrocephalus in a methanol poisoning patient. A confused 29-year-old gentleman was brought into hospital. Initial investigation showed severe metabolic acidosis with raised anion gap. Initial brain CT scan was normal. Subsequently, serum methanol was reported to be high (112 mg/dL). Intravenous (IV) ethanol 10% was given without any delayed. As there was no improvement in his consciousness level, a repeat brain CT was performed and it showed multiple cerebral hemorrhage with obstructive hydrocephalus. Hence, clinicians should have high index of suspicion for cerebral hemorrhage in a patient with methanol toxicity, who presented with altered mental status and severe metabolic acidosis.
  10. Allias Omar SM, Wan Ariffin WNH, Mohd Sidek L, Basri H, Moh Khambali MH, Ahmed AN
    Int J Environ Res Public Health, 2022 Dec 09;19(24).
    PMID: 36554413 DOI: 10.3390/ijerph192416530
    Extensive hydrological analysis is carried out to estimate floods for the Batu Dam, a hydropower dam located in the urban area upstream of Kuala Lumpur, Malaysia. The study demonstrates the operational state and reliability of the dam structure based on hydrologic assessment of the dam. The surrounding area is affected by heavy rainfall and climate change every year, which increases the probability of flooding and threatens a dense population downstream of the dam. This study evaluates the adequacy of dam spillways by considering the latest Probable Maximum Precipitation (PMP) and Probable Maximum Flood (PMF) values of the concerned dams. In this study, the PMP estimations are applied using comparison of both statistical method by Hershfield and National Hydraulic Research Institute of Malaysia (NAHRIM) Envelope Curve as input for PMF establishments. Since the PMF is derived from the PMP values, the highest design flood standard can be applied to any dam, ensuring inflow into the reservoirs and limiting the risk of dam structural failure. Hydrologic modeling using HEC-HMS provides PMF values for the Batu dam. Based on the results, Batu Dam is found to have 200.6 m3/s spillway discharge capacities. Under PMF conditions, the Batu dam will not face overtopping since the peak outflow of the reservoir level is still below the crest level of the dam.
  11. Tangahu BV, Sheikh Abdullah SR, Basri H, Idris M, Anuar N, Mukhlisin M
    Chemosphere, 2022 Mar;291(Pt 3):132952.
    PMID: 34798103 DOI: 10.1016/j.chemosphere.2021.132952
    Lead (Pb) is one of the toxic heavy metals that pollute the environment as a result of industrial activities. This study aims to optimize Pb removal from water by using horizontal free surface flow constructed wetland (HFSFCW) planted with Scirpus grossus. Optimization was conducted using response surface methodology (RSM) under Box-Behnken design with the operational parameters of initial Pb concentration, retention time, and aeration. Optimization results showed that 37 mg/L of initial Pb concentration, 32 days of retention time, and no aeration were the optimum conditions for Pb removal by using the systems. Validation test was run under two different conditions, namely, non-bioaugmented and bioaugmented with rhizobacteria (Bacillus cereus, B. pumilus, B. subtilis, Brevibacillus choshinensis, and Rhodococcus rhodochrous). Results of the validation test showed that Pb removal in water achieved 99.99% efficiency with 0.2% error from the RSM prediction, while the adsorption of Pb by plants reached 5160.18 mg/kg with 10.6% error from the RSM prediction. The bioaugmentation of the five rhizobacterial species showed a slight improvement in Pb removal from water and Pb adsorption by plants. However, no significant improvement was achieved (p 
  12. Musa NH, Thilakavathy K, Mohamad NA, Kennerson ML, Inche Mat LN, Loh WC, et al.
    Front Genet, 2022;13:972007.
    PMID: 36659963 DOI: 10.3389/fgene.2022.972007
    Myotonia congenita (MC) is a rare neuromuscular disease caused by mutations within the CLCN1 gene encoding skeletal muscle chloride channels. MC is characterized by delayed muscle relaxation during contraction, resulting in muscle stiffness. There is a lack of MC case reports and data on the prevalence among Malaysians. We report a clinical case of a 50-year-old woman presents with muscle stiffness and cramp episodes that started in early childhood. She had difficulty initiating muscle movement and presented with transient muscle weakness after rest, which usually improved after repeated contraction (warm-up phenomenon). She was diagnosed with MC after myotonic discharge on electromyography (EMG). Her brother had similar symptoms; however, no additional family members showed MC symptoms. Serum creatine kinase levels were elevated in both the proband and her brother with 447 U/L and 228 U/L recorded, respectively. Genetic analysis by whole-exome sequencing (WES) revealed a previously reported pathogenic CLCN1 gene variant c.1667T>A (p.I556N). Genetic screening of all family members revealed that the same variant was observed in the children of both the proband and her brother; however, the children did not present with either clinical or electrophysiological MC symptoms. The multiplex ligation-dependent probe amplification (MLPA) analysis conducted identified neither exon deletion nor duplication in CLCN1. In conclusion, this report describes the first case of MC in Malaysia in which incomplete penetrance observed in this family is caused by a known pathogenic CLCN1 variant.
  13. Tan WY, Yusof Khan AHK, Mohd Yaakob MN, Abdul Rashid AM, Loh WC, Baharin J, et al.
    BMC Neurol, 2021 Oct 12;21(1):395.
    PMID: 34641797 DOI: 10.1186/s12883-021-02427-x
    BACKGROUND: Transverse myelitis (TM) is a relatively uncommon condition, and vaccine-associated myelitis is even rarer. Concern regarding neurological complications following vaccination escalated following the report of TM during the safety and efficacy trials of the COVID-19 vaccine.

    CASE PRESENTATION: We report the first case of Longitudinal Extensive Transverse Myelitis (LETM) in Malaysia following administration of the chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine. A 25-year-old female presented with bilateral lower limb weakness and inability to walk with a sensory level up to T8 with absent visual symptoms. Urgent gadolinium-enhanced magnetic resonance imaging (MRI) of the spine showed long segment TM over the thoracic region. Cerebrospinal fluid autoantibodies for anti-aquaporin-4 and anti-myelin-oligodendrocyte were negative. A diagnosis of LETM following vaccination was made, and the patient was started on a high dose of intravenous methylprednisolone. The patient eventually made a recovery following treatment.

    CONCLUSION: LETM is a rare but serious adverse reaction following vaccination. Previously reported cases showed an onset of symptoms between 10 to 14 days post-vaccination, suggesting a delayed immunogenic reaction. However, the incidence of myelitis in COVID-19 is much more common, far greater than the risk associated with vaccination.

  14. Mohamad NA, Che Adinan SN, Yusof Khan AHK, Nik Abdul Ghani NNH, Kamis MFA, Wan Sulaiman WA, et al.
    Neurocase, 2021 Oct;27(5):391-395.
    PMID: 34478345 DOI: 10.1080/13554794.2021.1974487
    Pure alexia without agraphia is characterized by impaired reading due to damage to the occipitotemporal cortex with preserved writing skills. In this case report, we investigate the effect of multiple oral re-reading (MOR) therapy adjunct with transcranial direct current stimulation (tDCS) in improving reading recovery of a 64-year-old patient with pure alexia without agraphia following a stroke. His MRI revealed an area of infarct with microhemorrhages at the left occipitotemporal region. The patient was blinded to each therapy and underwent seven consecutive sessions of sham tDCS followed by seven consecutive sessions of real tDCS, coupled with 1-hour MOR therapy during each session. Western Aphasia Battery (WAB) was performed at baseline, before sham and real-tDCS, and 6 weeks after completing tDCS therapy. The patient showed improvement using both sham and real-tDCS with better reading comprehension, average reading time, and word per minute after real-tDCS. This study suggests that MOR, coupled with tDCS therapy may accelerate the reading recovery in patients with pure alexia.
  15. Jamari J, Ammarullah MI, Saad APM, Syahrom A, Uddin M, van der Heide E, et al.
    J Funct Biomater, 2021 Jun 06;12(2).
    PMID: 34204138 DOI: 10.3390/jfb12020038
    Wear and wear-induced debris is a significant factor in causing failure in implants. Reducing contact pressure by using a textured surface between the femoral head and acetabular cup is crucial to improving the implant's life. This study presented the effect of surface texturing as dimples on the wear evolution of total hip arthroplasty. It was implemented by developing finite element analysis from the prediction model without dimples and with bottom profile dimples of flat, drill, and ball types. Simulations were carried out by performing 3D physiological loading of the hip joint under normal walking conditions. A geometry update was initiated based on the patient's daily routine activities. Our results showed that the addition of dimples reduced contact pressure and wear. The bottom profile dimples of the ball type had the best ability to reduce wear relative to the other types, reducing cumulative linear wear by 24.3% and cumulative volumetric wear by 31% compared to no dimples. The findings demonstrated that surface texturing with appropriate dimple bottom geometry on a bearing surface is able to extend the lifetime of hip implants.
  16. Farzin A, Ibrahim R, Madon Z, Basri H, Farzin S, Motalebizadeh A
    Front Public Health, 2021;9:594953.
    PMID: 33968872 DOI: 10.3389/fpubh.2021.594953
    Prospective Memory (PM) is a cognitive function affected by aging. PM is the memory of future intentions and is significantly involved in everyday life, especially among older adults. Nevertheless, there are a few studies focused on PM training among healthy older adults and these studies did not report the optimal duration of training regarding improving PM performance among older adults. The present study aimed to determine the effective duration for training PM performance among healthy older adults. The current study was a randomized, controlled, single-blind, within-participants crossover trial including a training program with a duration of 12 h. The sample of 25 older adults aged 55 to 74 years recruited from the active members of the University of the Third Age (U3A), Kuala Lumpur/Selangor, their family members, and friends. The study design ensured some participants would receive the training after baseline while others would wait for 6 weeks after the baseline before receiving the training. All participants were evaluated five times: at baseline, 6, 12, 16, and at 24 weeks post-baseline. Moreover, the training program ensured all participants were assessed after each training session. The minimum number of hours to achieve training effects for this multi-component training program was eight. Results supported the efficacy of the training program in improving PM performance among healthy older adults. Also, the optimal duration for the multicomponent training program on PM performance among healthy older adults was obtained. This trial is registered at isrctn.com (#ISRCTN57600070).
  17. Mohamad Safiai NI, Mohamad NA, Basri H, Inche Mat LN, Hoo FK, Abdul Rashid AM, et al.
    PLoS One, 2021;16(6):e0251528.
    PMID: 34138860 DOI: 10.1371/journal.pone.0251528
    BACKGROUND: Migraine may lead to a negative impact on the patients' quality of life with a subsequent substantial burden to society. Therapy options for treatment and prevention of migraine have progressed over the years and repetitive transcranial magnetic stimulation (rTMS) is one of the promising non-pharmacological options. It induces and alters electric current in the brain via repetitive non-invasive brain stimulation in high frequency. In migraine patients, two common stimulation sites are the M1 cortex and dorsolateral prefrontal cortex (DLPFC). The mechanism on how rTMS exerts therapeutic effects on migraine is not fully established, but the main postulation is that the neuromodulation via high-frequency rTMS (hf-rTMS) might inhibit pain perception. However, evidence from studies has been conflicting, thus the usefulness of hf-rTMS as migraine preventive treatment is still uncertain at this moment.

    METHODS: This is a systematic review protocol describing essential reporting items based on the PRISMA for systematic review protocols (PRISMA-P) (Registration number: CRD42020220636). We aim to review the effectiveness, tolerability, and safety of hf-rTMS at DLPFC in randomised controlled trials (RCTs) as migraine prophylactic treatment. We will search Scopus, Cumulative Index to Nursing and Allied Health Literature Plus, PubMed, Cochrane Central Register of Controlled Trials and Biomed Central for relevant articles from randomised controlled clinical trials that used hf-rTMS applied at DLPFC for the treatment of migraine. The risk of bias will be assessed using the version 2 "Risk of bias" tool from Cochrane Handbook for Systematic Reviews of Interventions Version 6.1. We will investigate the evidence on efficacy, tolerability and safety and we will compare the outcomes between the hf-rTMS intervention and sham groups.

    DISCUSSION: This systematic review will further determine the efficacy, safety, and tolerability of hf-rTMS applied at DLPFC for migraine prophylaxis. It will provide additional data for health practitioners and policymakers about the usefulness of hf-rTMS for migraine preventive treatment.

  18. Mohamad Safiai NI, Amir NA, Basri H, Inche Mat LN, Hoo FK, Yusof Khan AHK, et al.
    Trials, 2020 Nov 11;21(1):923.
    PMID: 33176870 DOI: 10.1186/s13063-020-04832-y
    BACKGROUND: This is a phase II randomised, double-blind, sham-controlled trial to evaluate the effectiveness and tolerability of repetitive transcranial magnetic stimulation for preventive treatment of episodic migraine amongst migraine subjects.

    METHODS: Subjects age 18 to 60 years will undergo a baseline evaluation to establish the diagnosis of migraine based on the International Classification of Headache Disorder 3rd Edition (ICHD-3). Those who fulfil the ICHD-3 criteria for episodic migraine and compliant to the headache diary during a month run-in period will be enrolled. A total of 76 subjects will be randomised to receive either transcranial magnetic stimulation or sham stimulation for 5 sessions within 2 weeks duration. Follow-up sessions will be conducted monthly for three consecutive months. Prior to treatment, subjects will be required to fill up questionnaires and undergo few procedures such as electroencephalography, transcranial Doppler ultrasound and biochemical analysis for serum serotonin, serum calcitonin gene-related peptide and serum beta-endorphin. These procedures will be repeated at month 3 after receiving the last treatment. The primary outcome measure of this study is the difference in mean monthly migraine days at baseline and at months 1, 2 and 3 after treatment sessions.

    DISCUSSION: Following evidence from previous studies showing restoration of dorsolateral prefrontal cortex (DLPFC) activation to almost normal level, the rTMS intervention will target left DLPFC in this study. An intermediate duration of treatment sessions is selected for this study. It is set to five treatment sessions given within 2 weeks duration.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT03556722 . Registered on 14 June 2018.

  19. Abootalebi S, Aertker BM, Andalibi MS, Asdaghi N, Aykac O, Azarpazhooh MR, et al.
    J Stroke Cerebrovasc Dis, 2020 Sep;29(9):104938.
    PMID: 32807412 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104938
    BACKGROUND AND PURPOSE: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.

    METHODS: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center.

    CONCLUSION: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

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