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Fulltext Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists

Abdul Aziz AF, Mohd Nordin NA, Abd Aziz N, Abdullah S, Sulong S, Aljunid SM

BMC Fam Pract, 2014;15:40.
PMID: 24580779 DOI: 10.1186/1471-2296-15-40

BACKGROUND: Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services.
METHODS: A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached.
RESULTS: Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on 'as needed' basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS' perceived 4 important 'needs' in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support.
CONCLUSIONS: Post discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community.
Fulltext The integrated care pathway for managing post stroke patients (iCaPPS©) in public primary care Healthcentres in Malaysia: impact on quality adjusted life years (QALYs) and cost effectiveness analysis

Abdul Aziz AF, Mohd Nordin NA, Muhd Nur A, Sulong S, Aljunid SM

BMC Geriatr, 2020 02 18;20(1):70.
PMID: 32070291 DOI: 10.1186/s12877-020-1453-z

BACKGROUND: The delivery of post stroke care is fragmented even in advanced public healthcare systems, globally. Primary care teams are entrusted to provide longer term care for stroke survivors in most developing countries. The integrated Care Pathway for Post Stroke patients (iCaPPS©) was designed to guide primary care teams to incorporate further rehabilitation and regular screening for post stroke complications among patients residing at home in communities, using the shared-care approach, especially in areas with limited access to specialist stroke care services. The iCaPPS© addressed coordination of rehabilitation and screening for post stroke complications which were absent in the current conventional care of patients managed at public primary care healthcentres. This study aimed to evaluate the cost effectiveness and impact of iCaPPS© on quality-adjusted- life-years (QALY) compared with current conventional monitoring at public primary care healthcentres.
METHODS: A pragmatic healthcentre-based cluster randomised controlled trial-within trial on 151 post stroke patients from 10 public primary care facilities in Peninsular Malaysia was conducted to evaluate QALY of patients managed with iCaPPS© (n = 86) vs conventional care (n = 65) for 6 months. Costs from societal perspective were calculated, using combination of top down and activity-based costing methods. The 5-level EQ5D (EQ-5D-5 L) was used to calculate health state utility scores. Cost per QALY and incremental cost effectiveness ratio (ICER) were determined. Differences within groups were determined using Mann-Whitney tests.
RESULTS: Total costs for 6 months treatment with iCaPPS© was MYR790.34, while conventional care cost MYR527.22. Median QALY for iCaPPS© was 0.55 (0,1.65) compared to conventional care 0.32 (0, 0.73) (z = - 0.21, p = 0.84). Cost per QALY for iCaPPS© was MYR1436.98, conventional care was MYR1647.56. The ICER was MYR1144.00, equivalent to 3.7% of per capita GDP (2012 prices).
CONCLUSIONS: Management of post stroke patients in the community using iCaPPS© costs less per QALY compared to current conventional care and is very cost effective.
TRIAL REGISTRATION: Trial Registration number ACTRN12616001322426. Registered 21 September 2016. (Retrospectively registered).
Fulltext The integrated care pathway for post stroke patients (iCaPPS): a shared care approach between stakeholders in areas with limited access to specialist stroke care services

Abdul Aziz AF, Mohd Nordin NA, Ali MF, Abd Aziz NA, Sulong S, Aljunid SM

BMC Health Serv Res, 2017 Jan 13;17(1):35.
PMID: 28086871 DOI: 10.1186/s12913-016-1963-8

BACKGROUND: Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking.

METHODS: Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres.

RESULTS: Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems.

CONCLUSION: Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services.

TRIAL REGISTRATION: No.: ACTRN12616001322426 (Registration Date: 21st September 2016).
Fulltext Enhancement of Viscoelastic and Electrical Properties of Magnetorheological Elastomers with Nanosized Ni-Mg Cobalt-Ferrites as Fillers

Abdul Aziz SA, Mazlan SA, Ubaidillah U, Shabdin MK, Yunus NA, Nordin NA, et al.

Materials (Basel), 2019 Oct 28;12(21).
PMID: 31661837 DOI: 10.3390/ma12213531

Carbon-based particles, such as graphite and graphene, have been widely used as a filler in magnetorheological elastomer (MRE) fabrication in order to obtain electrical properties of the material. However, these kinds of fillers normally require a very high concentration of particles to enhance the conductivity property. Therefore, in this study, the nanosized Ni-Mg cobalt ferrite is introduced as a filler to soften MRE and, at the same time, improve magnetic, rheological, and conductivity properties. Three types of MRE samples without and with different compositions of Mg, namely Co0.5Ni0.2Mg0.3Fe2O4 (A1) and Co0.5Ni0.1Mg0.4Fe2O4 (A2), are fabricated. The characterization related to the micrograph, magnetic, and rheological properties of the MRE samples are analyzed using scanning electron microscopy (SEM), vibrating sample magnetometer (VSM), and the rheometer. Meanwhile, the effect of the nanosized Ni-Mg cobalt ferrites on the electrical resistance property is investigated and compared with the different Mg compositions. It is shown that the storage modulus of the MRE sample with the nanosized Ni-Mg cobalt ferrites is 43% higher than that of the MRE sample without the nanomaterials. In addition, it is demonstrated that MREs with the nanosized Ni-Mg cobalt ferrites exhibit relatively low electrical resistance at the on-state as compared to the off-state condition, because MRE with a higher Mg composition shows lower electrical resistance when higher current flow occurs through the materials. This salient property of the proposed MRE can be effectively and potentially used as an actuator to control the viscoelastic property of the magnetic field or sensors to measure the strain of the flexible structures by the electrical resistance signal.
Fulltext The effect of salt water ageing on the mechanical and rheological properties of magnetorheological elastomer

Ahmad Khairi MH, Mazlan SA, Ubaidillah U, Khaidir REM, Nordin NA, Johari MAF, et al.

Sci Rep, 2023 Apr 10;13(1):5810.
PMID: 37037883 DOI: 10.1038/s41598-023-33171-6

This paper aims to investigate the mechanical and rheological properties of magnetorheological elastomer (MRE) in marine ecosystems. The prepared samples comprised silicone rubber (SR) and 70 wt% micron-sized carbonyl iron particles (CIPs), immersed in an artificial marine ecosystem using salt water (Natrium Chloride) for 30 days. The mechanical properties of MRE samples were evaluated using hardness and quasi-static tensile tests. While the rheometer was used to investigate the rheological properties of their storage modulus condition with magnetic field stimulation. Further analysis of the defects and damages caused by salt water ageing was done through morphological observation using scanning electron microscope (SEM) technology. The results showed that the hardness and tensile strength of MRE samples that were soaked in salt water were affected over time. Lower values of hardness and tensile strength were obtained after 30 days due to the presence of Na+ and Cl-, which acted as an accelerator to the hydrolyzation process of the MRE. The process then, enhanced the water ingress capability into the matrix to cause the molecular changes. Interestingly, for rheological properties, 30 days of salt water ageing allowed the water molecules to move the MRE matrix molecular chains apart, a process known as plasticization and thus increasing the MR effect. Furthermore, morphological evidence was established to determine the MRE changes during salt water ageing. The research findings should greatly contribute to a better understanding of the effect of salt water on the performance of MRE.
Fulltext Virtual Reality Games as an Adjunct in Improving Upper Limb Function and General Health among Stroke Survivors

Ahmad MA, Singh DKA, Mohd Nordin NA, Hooi Nee K, Ibrahim N

Int J Environ Res Public Health, 2019 12 16;16(24).
PMID: 31888293 DOI: 10.3390/ijerph16245144

Virtual reality (VR) games has the potential to improve patient outcomes in stroke rehabilitation. However, there is limited information on VR games as an adjunct to standard physiotherapy in improving upper limb function. This study involved 36 participants in both experimental (n = 18) and control (n = 18) groups with a mean age (SD) of 57 (8.20) and 63 (10.54) years, respectively. Outcome measures were the Fugl-Meyer assessment for upper extremities (FMA-UE), Wolf motor function test (WMFT), intrinsic motivation inventory (IMI), Lawton of instrumental activities of daily living (IADL), and stroke impact scale (SIS) assessed at pre-post intervention. The experimental group had 0.5 h of upper limb (UL) VR games with 1.5 h of standard physiotherapy, and the control group received 2 h of standard physiotherapy. The intervention for both groups was performed once a week for eight consecutive weeks. The results showed a significant time-group interaction effect for IMI (p = 0.001), Lawton IADL (p = 0.01) and SIS domain of communication (p = 0.03). A significant time effect was found in FMA-UE (p = 0.001), WMFT (p = 0.001), Lawton IADL (p = 0.01), and SIS domains; strength, ADL and stroke recovery (p < 0.05). These results indicated an improvement in UL motor ability, sensory function, instrumental ADL, and quality of life in both groups after eight weeks of intervention. However, no significant (p > 0.05) group effect on all the outcome measures was demonstrated. Thus, replacing a portion of standard physiotherapy time with VR games was equally effective in improving UL function and general health compared to receiving only standard physiotherapy among stroke survivors.
Fulltext Effect of increasing heart rate on finger photoplethysmography fitness index (PPGF) in subjects with implanted cardiac pacemakers

Aminuddin A, Tan I, Butlin M, Avolio AP, Kiat H, Barin E, et al.

PLoS One, 2018;13(11):e0207301.
PMID: 30485318 DOI: 10.1371/journal.pone.0207301

Finger photoplethysmography (PPG) is a noninvasive method that measures blood volume changes in the finger. The PPG fitness index (PPGF) has been proposed as an index of vascular risk and vascular aging. The objectives of the study were to determine the effects of heart rate (HR) on the PPGF and to determine whether PPGF is influenced by blood pressure (BP) changes. Twenty subjects (78±8 years, 3 female) with permanent cardiac pacemakers or cardioverter defibrillators were prospectively recruited. HR was changed by pacing, in a random order from 60 to 100 bpm and in 10 bpm increments. At each paced HR, the PPGF was derived from a finger photoplethysmogram. Cardiac output (CO), stroke volume (SV) and total peripheral resistance (TPR) were derived from the finger arterial pressure waveform. Brachial blood pressure (BP) was measured by the oscillometric method. This study found that as HR was increased from 60 to 100 bpm, brachial diastolic BP, brachial mean BP and CO were significantly increased (p<0.01), whilst the PPGF and SV were significantly decreased (p<0.001). The effects of HR on the PPGF were influenced by BP, with a decreasing HR effect on the PPGF that resulted from a higher BP. In conclusion, HR was a significant confounder for PPGF and it must be taken into account in analyses of PPGF, when there are large changes or differences in the HR. The magnitude of this effect was BP dependent.
Augmentation index is a better marker for cardiovascular risk in young Malaysian males. A comparison of involvement of pulse wave velocity, augmentation index, and C-reactive protein

Aminuddin A, Chellappan K, Maskon O, Zakaria Z, Karim AA, Ngah WZ, et al.

Saudi Med J, 2014 Feb;35(2):138-46.
PMID: 24562512

To determine the association between carotid femoral pulse wave velocity (PWVCF) and augmentation index (AI) with future cardiovascular disease (CVD) risk, and to assess whether high sensitivity C-reactive protein (hs-CRP) is an important mediator towards these vascular changes, among young men.
High C reactive protein associated with increased pulse wave velocity among urban men with metabolic syndrome in Malaysia

Aminuddin A, Zakaria Z, Fuad AF, Kamsiah J, Othman F, Das S, et al.

Saudi Med J, 2013 Mar;34(3):266-75.
PMID: 23475091

To determine the association between carotid femoral pulse wave velocity (PWVCF); augmentation index (AI); and high-sensitivity C reactive protein (hs-CRP) with metabolic syndrome (MetS), and to determine the influence of ethnicity on PWVCF and AI, and the association between high hs-CRP and increased PWV, and AI in MetS.
Effect of methanolic extract of Piper sarmentosum leaves on neointimal foam cell infiltration in rabbits fed with high cholesterol diet

Amran AA, Zakaria Z, Othman F, Das S, Al-Mekhlafi HM, Raj S, et al.

EXCLI J, 2012;11:274-83.
PMID: 27366140

Previous research has shown the beneficial effects of aqueous extract of Piper sarmentosum (P.s) on atherosclerosis. The first stage in atherosclerosis is the formation of foam cell. The aim of this study was to investigate the effect of the methanol extract of P.s on fatty streaks by calculating neointimal foam cell infiltration in rabbits fed with high cholesterol diet. Thirty six male New Zealand white rabbits were divided equally into six groups: (i) C: control group fed normal rabbit chow; (ii) CH: cholesterol diet (1 % cholesterol); (iii) PM1: 1 % cholesterol with methanol extract of P.s (62.5 mg/kg); (iv) PM2: 1 % cholesterol with methanol extract of P.s (125 mg/kg); (v) PM3: 1 % cholesterol with methanol extract of P.s (250 mg/kg); (vi) SMV group fed 1 % cholesterol supplemented with Simvistatin drug (1.2 mg/kg). All animals were treated for 10 weeks. At the end of the treatment, the rabbits were fasted and sacrificed and the aortic tissues were collected for histological studies to measure the area of the neointimal foam cell infiltration using software. The thickening of intima ratio of atherosclerosis and morphological changes by scanning electron microscope were measured. The results showed that the atherosclerotic group had significantly bigger area of fatty streak compared to the control group. The area of fatty streak in the abdominal aorta was significantly reduced in the treatment groups which were similar with the SMV group. Similarly, there was a reduction in the number of foam cell in the treatment groups compared to the atherosclerotic group as seen under scanning microscope. In conclusion, histological study demonstrated that the methanol extract of the P.s could reduce the neointimal foam cell infiltration in the lumen of the aorta and the atherosclerotic lesion.
Fulltext Aqueous extract of Piper sarmentosum decreases atherosclerotic lesions in high cholesterolemic experimental rabbits

Amran AA, Zakaria Z, Othman F, Das S, Raj S, Nordin NA

Lipids Health Dis, 2010 Apr 30;9:44.
PMID: 20433693 DOI: 10.1186/1476-511X-9-44

BACKGROUND: Piper sarmentosum (P.s) has flavonoid component in its leaves which has antioxidative effect. To date, its effect on atherosclerosis has not been studied histologically.
AIM: The study aimed to investigate the effect of P.s on atherosclerotic changes in hypercholesterolemic rabbits.
METHODS: Forty two male New Zealand white rabbits were divided into seven groups. C - control group fed normal rabbit chow, CH - cholesterol diet (1% cholesterol), W1 - 1% cholesterol with water extract of P.s (62.5 mg/kg), W2 - 1% cholesterol with water extract of P.s (125 mg/kg), W3 - 1% cholesterol with water extract of P.s (250 mg/kg), W4 - 1% cholesterol with water extract of P.s (500 mg/kg) and Smv - 1% cholesterol supplemented with simvistatin drug (1.2 mg/kg). All rabbits were treated for 10 weeks. Following 10 weeks of supplementation, the animals were sacrificed and the aortic tissue was taken for histological study.
RESULTS: Rabbits fed only with high cholesterol diet 1% cholesterol (CH) showed focal fatty streak lesions compared to the C group and 1% cholesterol supplemented with simvistatin drug (Smv) group. Atherosclerotic lesions in the 1% cholesterol group supplemented with P.s (500 mg/kg) i.e. W4 group showed significant reduction (30 + or - 6.0%, p < 0.05) in fatty streak compared to the high cholesterol group (85.6 + or - 4.1%) under Sudan IV stain. The atherosclerotic lesions under transmission electron microscope showed reduction in foam cells in the treatment groups compared to the CH groups.
CONCLUSION: Administration of P.s extract has protective effect against atheroscleros.
Fulltext Changes in the vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and c-reactive protein following administration of aqueous extract of piper sarmentosum on experimental rabbits fed with cholesterol diet

Amran AA, Zakaria Z, Othman F, Das S, Al-Mekhlafi HM, Nordin NA

Lipids Health Dis, 2011 Jan 09;10:2.
PMID: 21214952 DOI: 10.1186/1476-511X-10-2

BACKGROUND: Inflammation process plays an important role in the development of atherosclerosis. Hypercholesterolemia is one of the major risk factors for atherosclerosis. The present study aimed to evaluate the effect of aqueous extract of Piper sarmentosum (P.s) on inflammatory markers like vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and C-reactive protein (CRP).
METHODS: Forty two male New Zealand white rabbits were divided equally into seven groups; (i) C- control group fed normal rabbit chow (ii) CH- cholesterol diet (1%cholesterol) (iii) X1- 1% cholesterol with water extract of P.s (62.5 mg/kg) (iv) X2- 1% cholesterol with water extract of P.s (125 mg/kg (v) X3- 1% cholesterol with water extract of P.s (250 mg/kg) (vi) X4- 1% cholesterol with water extract of P.s (500 mg/kg) and (vii) SMV group fed with 1% cholesterol supplemented with simvistatin drug (1.2 mg/kg). All animals were treated for 10 weeks. Blood serum was taken for observing the inflammatory markers at the beginning and end of the experiment.
RESULTS: Rabbits fed with 1% cholesterol diet (CH) showed significant increase in the level of VCAM-1, ICAM-1 and CRP compared to the C group. The levels of VCAM-1, ICAM-1 and CRP in the 1% cholesterol group and supplemented with P.s (500 mg/kg) were significantly reduced compared to the cholesterol group. Similar results were also reported with simvistatin group.
CONCLUSION: These results suggest that the supplementation of Piper sarmentosum extract could inhibit inflammatory markers which in turn could prevent atherosclerosis.
Fulltext What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic

Aziz AF, Aziz NA, Nordin NA, Ali MF, Sulong S, Aljunid SM

J Neurosci Rural Pract, 2013 Oct;4(4):413-20.
PMID: 24347948 DOI: 10.4103/0976-3147.120243

CONTEXT: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community.
AIMS: We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level.
SETTINGS AND DESIGN: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility.
SUBJECTS AND METHODS: Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI).
STATISTICAL ANALYSIS USED: Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05.
RESULTS: Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD) 10.9] years, mean stroke episodes were 1.30 (SD 0.5). The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0) months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007), while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06). Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2-100) to 90.5 (range: 27-100) (Z = 2.34, P = 0.01). Median PHQ9 scores decreased from 4.0 (range: 0-22) to 3.0 (range: 0-19) though the change was not significant (Z= -0.744, P = 0.457).
CONCLUSIONS: Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level.
Fulltext Trait Emotional Intelligence and Happiness of Young Adults: The Mediating Role of Perfectionism

Badri SKZ, Kong MY, Wan Mohd Yunus WMA, Nordin NA, Yap WM

Int J Environ Res Public Health, 2021 10 14;18(20).
PMID: 34682544 DOI: 10.3390/ijerph182010800

Perfectionism or a tendency to aim for an unrealistic standard can impair happiness. However, the potential mechanisms of perfectionism to explain the association between trait emotional intelligence (EI) and happiness are still understudied. This study explores the mediating role of perfectionism in the relationship between trait emotional intelligence (EI) and happiness among young adults. A cross-sectional sample of 259 young adults aged between 18 to 35 years old was recruited. All analyses were conducted using SPSS and AMOS Structural Equation Modeling. High trait EI was linked to low perfectionism and high happiness levels. Furthermore, perfectionism mediated the relationship between trait EI and happiness. Although high trait EI lowered maladaptive perfectionism, the negative impact of maladaptive perfectionism remained and subsequently led to decreasing happiness levels of young adults. This study offers an enhanced understanding of the role of perfectionism in explaining the happiness state of young adults. Moreover, it provides practical implications for using trait EI and managing perfectionism tendency to manage the happiness and wellbeing of the young adult population.
Fulltext Physicochemical characterization and rheological properties of magnetic elastomers containing different shapes of corroded carbonyl iron particles

Burhannuddin NL, Nordin NA, Mazlan SA, Aziz SAA, Kuwano N, Jamari SKM, et al.

Sci Rep, 2021 Jan 13;11(1):868.
PMID: 33441824 DOI: 10.1038/s41598-020-80539-z

Carbonyl iron particles (CIPs) is one of the key components in magnetic rubber, known as magnetorheological elastomer (MRE). Apart from the influence of their sizes and concentrations, the role of the particle' shape is pronounced worthy of the attention for the MRE performance. However, the usage of CIPs in MRE during long-term applications may lead to corrosion effects on the embedded CIPs, which significantly affects the performance of devices or systems utilizing MRE. Hence, the distinctions between the two types of MRE embedded in different shapes of spherical and plate-like CIPs, at both conditions of non-corroded and corroded CIPs were investigated in terms of the field-dependent rheological properties of MRE. The plate-like shape was produced from spherical CIPs through a milling process using a rotary ball mill. Then, both shapes of CIPs individually subjected to an accelerated corrosion test in diluted hydrochloric (HCl) at different concentrations, particularly at 0.5, 1.0, and 1.5 vol.% for 30 min of immersion time. Eight samples of CIPs, including non-corroded for both CIPs shapes, were characterized in terms of a morphological study by field emission scanning electron microscope (FESEM) and magnetic properties via vibrating sample magnetometer (VSM). The field-dependent rheological properties of MREs were analyzed the change in the dynamic modulus behavior of MREs via rheometer. From the application perspective, this finding may be useful for the system to be considered that provide an idea to prolong the performance MRE by utilizing the different shapes of CIPs even when the material is fading.
Fulltext Body mass index and factors related to overweight among women workers in electronic factories in Peninsular Malaysia

Chee HL, Kandiah M, Khalid M, Shamsuddin K, Jamaluddin J, Nordin NA, et al.

Asia Pac J Clin Nutr, 2004;13(3):248-54.
PMID: 15331336

Factors related to overweight were examined in a cross-sectional survey that included 1612 women workers from 10 large electronics assembly factories in Peninsular Malaysia. Respondents were Malaysian citizens, direct production workers below the supervisory level, and had worked at least a year in the factory where they were presently employed. Heights and weights were taken to calculate the body mass index (BMI). Weights and BMI increased with increasing age. After adjusting for age, odds ratios for overweight were significantly raised for married women in relation to not married women (OR 1.5, 95% CI=1.15-2.02), lower secondary education in relation to higher than upper secondary education (OR 1.8, 95% CI=1.06-3.14), monthly income RM800-999 (OR 1.7, 95% CI=1.21-2.45) and >/=RM1,000 (OR 1.8, 95% CI=1.23-2.72) in relation to
Fulltext Effect of constraint-induced movement therapy combined with neuromuscular electrical stimulation on upper extremity function in stroke survivors: A protocol for systematic review

Dboba MM, Mohd Nordin NA, Manaf H, Mohd Rasdi HF

Medicine (Baltimore), 2023 Jul 14;102(28):e34249.
PMID: 37443502 DOI: 10.1097/MD.0000000000034249

BACKGROUND: Motor impairment is common after a stroke and directly affects the function and quality of life of stroke survivors. Constraint-induced movement therapy and neuromuscular electrical stimulation are interventions that facilitate functional recovery of the upper extremities of a particular subgroup of stroke survivors. The objective of this study was to summarize the available evidence on the effects of neuromuscular electrical stimulation combined with constraint-induced movement therapy in patients with stroke.
METHODS: We conducted a comprehensive search of published articles in electronic databases, including PubMed, Scopus, PEDro, Medline (via Ovid), EMBASE, Cochrane Library, and Web of Science, using the following search terms: "stroke"; "upper extremity"; "Constraint-Induced Movement Therapy"; and "Neuromuscular Electrical Stimulation." The search included published studies, conferences, and presentations. The article selection, data extraction, and quality evaluation will be conducted independently by 2 reviewers. The 3rd and 4th reviewers will assist in resolving any disagreements that may arise between the 2 reviewers. The risk of bias in the included studies will be assessed using the PEDro scale and Cochrane risk of bias assessment tool. Narrative synthesis and meta-analysis will be performed based on the characteristics of the included articles, including the risk of bias (if sufficient information is available).
RESULTS: This review summarizes the available evidence and could assist therapists in choosing the best treatment for poststroke upper extremity dysfunction.
CONCLUSION: This study will provide the available evidence on the effectiveness of CIMT and NMES on upper extremity function in patients with stroke.
ETHICS AND DISSEMINATION: Ethical approval is not required because the review will be based on publicly available literature. The findings of this study will be published in a peer-reviewed journal, and updates will be made depending on whether sufficient additional evidence modifies the conclusions of the review. Any changes made to the methods throughout the review will be stated in the article.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023415645.
The fate of adipose tissue and adipose-derived stem cells in allograft

Farhana S, Kai YC, Kadir R, Sulaiman WAW, Nordin NA, Nasir NAM

Cell Tissue Res, 2023 Nov;394(2):269-292.
PMID: 37624425 DOI: 10.1007/s00441-023-03827-w

Utilizing adipose tissue and adipose-derived stem cells (ADSCs) turned into a promising field of allograft in recent years. The therapeutic potential of adipose tissue and ADSCs is governed by their molecular secretions, ability to sustain multi-differentiation and self-renewal which are pivotal in reconstructive, genetic diseases, and cosmetic goals. However, revisiting the existing functional capacity of adipose tissue and ADSCs and their intricate relationship with allograft is crucial to figure out the remarkable question of safety to use in allograft due to the growing evidence of interactions between tumor microenvironment and ADSCs. For instance, the molecular secretions of adipose tissue and ADSCs induce angiogenesis, create growth factors, and control the inflammatory response; it has now been well determined. Though the existing preclinical allograft studies gave positive feedback, ADSCs and adipose tissue are attracted by some factors of tumor stroma. Moreover, allorecognition is pivotal to allograft rejection which is carried out by costimulation in a complement-dependent way and leads to the destruction of the donor cells. However, extensive preclinical trials of adipose tissue and ADSCs in allograft at molecular level are still limited. Hence, comprehensive immunomodulatory analysis could ensure the successful allograft of adipose tissue and ADSCs avoiding the oncological risk.
Fulltext The multifaceted impact of structured training program on persons with Parkinson disease and their adult caregiver: A protocol for a systematic review

Gopala Krishna Pillai S, Mohd Nordin NA, Mohamed Ibrahim N

Medicine (Baltimore), 2023 Jul 14;102(28):e33966.
PMID: 37443466 DOI: 10.1097/MD.0000000000033966

BACKGROUND: Training caregivers and persons with Parkinson Disease (PwPD) is crucial to provide them with adequate knowledge and care skills in preparation for the Parkinson disease (PD) progression. This review will systematically evaluate the effect of structured training programs on the mobility and quality of life (QoL) of PwPD. In addition, the effect of such training programs on the QoL, burden of caregiving, and knowledge of PD among adult caregivers of PwPD will also be evaluated.
METHODS: Systematic and comprehensive search of relevant studies will be conducted using electronic databases such as Cochrane Library, EBSCOhost, PubMed, SCOPUS, and Web of Science. The title, abstract, keywords, and full texts will be screened for eligibility. Studies to be selected are randomized controlled trials (RCT) from inception until April 2023. Studies based on structured PD training either in the form of training, education, program, multidisciplinary approach, or self-management targeted at both PwPD and their adult caregivers will be selected. Only full-text articles available in the English language will be included. Full-text articles will be inspected by 2 independent reviewers to produce the final set of articles that meet the eligibility criteria. A third reviewer will be engaged if no consensus is achieved between the first and second reviewers. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) will be used to evaluate the quality of papers and inform the risk of bias.
RESULTS: This review will provide an outlook on the effects of structured PD training programs on mobility and QoL of PwPD. In addition, it will provide insight into the effects of such training on the caregivers' burden, knowledge of PD, and QoL.
CONCLUSION: This review findings may help clinicians and researchers to understand the effect of structured and comprehensive PD training programs for PwPD and their adult caregiver.
Fulltext Dual Properties of Polyvinyl Alcohol-Based Magnetorheological Plastomer with Different Ratio of DMSO/Water

Hapipi NM, Mazlan SA, Ubaidillah U, Abdul Aziz SA, Choi SB, Nordin NA, et al.

Sensors (Basel), 2021 Nov 22;21(22).
PMID: 34833835 DOI: 10.3390/s21227758

Polyvinyl alcohol (PVA)-based magnetorheological plastomer (MRP) possesses excellent magnetically dependent mechanical properties such as the magnetorheological effect (MR effect) when exposed to an external magnetic field. PVA-based MRP also shows a shear stiffening (ST) effect, which is very beneficial in fabricating pressure sensor. Thus, it can automatically respond to external stimuli such as shear force without the magnetic field. The dual properties of PVA-based MRP mainly on the ST and MR effect are rarely reported. Therefore, this work empirically investigates the dual properties of this smart material under the influence of different solvent compositions (20:80, 40:60, 60:40, and 80:20) by varying the ratios of binary solvent mixture (dimethyl sulfoxide (DMSO) to water). Upon applying a shear stress with excitation frequencies from 0.01 to 10 Hz, the storage modulus (G') for PVA-based MRP with DMSO to water ratio of 20:40 increases from 6.62 × 10-5 to 0.035 MPa. This result demonstrates an excellent ST effect with the relative shear stiffening effect (RSTE) up to 52,827%. In addition, both the ST and MR effect show a downward trend with increasing DMSO content to water. Notably, the physical state of hydrogel MRP could be changed with different solvent ratios either in the liquid-like or solid-like state. On the other hand, a transient stepwise experiment showed that the solvent's composition had a positive effect on the arrangement of CIPs within the matrix as a function of the external magnetic field. Therefore, the solvent ratio (DMSO/water) can influence both ST and MR effects of hydrogel MRP, which need to be emphasized in the fabrication of hydrogel MRP for appropriate applications primarily with soft sensors and actuators for dynamic motion control.

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