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Chronic diseases, depressive symptoms and functional limitation amongst older people in rural Malaysia, a middle income developing country

Hairi NN, Bulgiba A, Mudla I, Said MA

Prev Med, 2011 Oct;53(4-5):343-6.
PMID: 21864564 DOI: 10.1016/j.ypmed.2011.07.020

To determine prevalence and prevalence ratio of functional limitation amongst older people with combined chronic diseases and co-morbid depressive symptoms compared with older people with either chronic disease or depressive symptoms alone.
Fulltext Metabolic syndrome and cardiovascular risk among patients with schizophrenia receiving antipsychotics in Malaysia

Said MA, Sulaiman AH, Habil MH, Das S, Bakar AK, Yusoff RM, et al.

Singapore Med J, 2012 Dec;53(12):801-7.
PMID: 23268153

INTRODUCTION:This study aimed to determine the prevalence of metabolic syndrome and risk of coronary heart disease (CHD) in patients with schizophrenia receiving antipsychotics in Malaysia.
METHODS:This cross-sectional study, conducted at multiple centres, involved 270 patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR diagnostic criteria for schizophrenia, were on antipsychotic medications for at least one year, and were screened for metabolic syndrome. Patients receiving mood stabilisers were excluded. Metabolic syndrome was defined according to the National Cholesterol Education Program ATP III criteria modified for Asian waist circumference. Risk for cardiovascular disease was assessed by using Framingham function (all ten-year CHD events).
RESULTS:The prevalence of metabolic syndrome was 46.7% (126/270). Among all the antipsychotics used, atypical antipsychotics (monotherapy) were most commonly used in both the metabolic and non-metabolic syndrome groups (50.8% vs. 58.3%). The ten-year risk for CHD was significantly higher in patients with metabolic syndrome. The proportion of patients with high/very high risk for CHD (Framingham ≥ 10%) was greater in patients with metabolic syndrome than in those with non-metabolic syndrome (31.5% vs. 11.0%, odds ratio 3.9, 95% confidence interval 2.0-7.6; p < 0.001). The mean body mass index was higher in patients with metabolic syndrome than in those without (29.4 ± 5.1 kg/m2 vs. 25.0 ± 5.6 kg/m2; p < 0.001).
CONCLUSION:Patients with schizophrenia receiving antipsychotics in Malaysia have a very high incidence of metabolic syndrome and increased cardiovascular risk. Urgent interventions are needed to combat these problems in patients.
Numerical simulation of undular jumps on graveled bed using volume of fluid method

Rostami F, Yazdi SR, Said MA, Shahrokhi M

Water Sci Technol, 2012;66(5):909-17.
PMID: 22797216 DOI: 10.2166/wst.2012.213

Undular hydraulic jumps are characterized by a smooth rise of the free surface, followed by a train of stationary waves. These jumps sometimes occur in natural waterways and rivers. Numerical difficulties are especially distinct when the flow condition is close to the critical value because of the high sensitivity of the near-critical flow field to flow and channel conditions. Furthermore, the free surface has a wavy shape, which may indicate the occurrence of several transitions from supercritical to subcritical states and vice versa (i.e., undular hydraulic jumps). In this study, a flow model is used to predict an undular hydraulic jump in a rectangular open channel. The model is based on the general two-dimensional, Reynolds-averaged, Navier-Stokes flow equations. The resulting set of partial differential equations is solved using the FLOW-3D solver. The results are compared with the experimental data to validate the model. The comparative analysis shows that the proposed model yields good results. Several types of undular hydraulic jumps occurring in different situations are then simulated to prove the potential application of the model.
A randomized, placebo-controlled trial of aripiprazole for the treatment of methamphetamine dependence and associated psychosis

Sulaiman AH, Gill JS, Said MA, Zainal NZ, Hussein HM, Guan NC

Int J Psychiatry Clin Pract, 2013 Jun;17(2):131-8.
PMID: 22486597 DOI: 10.3109/13651501.2012.667116

The objectives of this study were to determine the efficacy and safety of aripiprazole for treatment of psychosis, retention and abstinence in patients with methamphetamine dependence.
Metabolic syndrome and antipsychotic monotherapy treatment among schizophrenia patients in Malaysia

Said MA, Hatim A, Habil MH, Zafidah W, Haslina MY, Badiah Y, et al.

Prev Med, 2013;57 Suppl:S50-3.
PMID: 23337566 DOI: 10.1016/j.ypmed.2013.01.005

OBJECTIVE: The objective of this study is to determine the prevalence of metabolic syndrome among schizophrenia patients receiving antipsychotic monotherapy in Malaysia.
METHOD: A cross-sectional study was conducted at multiple centres between June 2008 and September 2011. Two hundred and five patients who fulfilled the DSM IV-TR diagnostic criteria for schizophrenia and who had been on antipsychotic medication for at least one year, were screened for metabolic syndrome. Patients receiving a mood stabilizer were excluded from the study. Metabolic syndrome was defined by using the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Treatment Panel III (ATP III) modified for Asian waist circumference.
RESULTS: In the first-generation antipsychotic (FGA) group, the highest prevalence of metabolic syndrome was among patients treated with trifluoperazine and flupenthixol decanoate (66.7% each). For the second-generation antipsychotic (SGA) group, the highest prevalence of metabolic syndrome was among patients treated with clozapine (66.7%). The component with the highest prevalence in metabolic syndrome was waist circumference in both FGA and SGA groups except for aripiprazole in SGA.
CONCLUSION: The prevalence of metabolic syndrome in schizophrenia patients receiving antipsychotic monotherapy in Malaysia was very high. Intervention measures are urgently needed to combat these problems.
KEYWORDS: Antipsychotics; Metabolic syndrome; Monotherapy; Prevalence; Schizophrenia
Association of ADRA2A and MTHFR gene polymorphisms with weight loss following antipsychotic switching to aripiprazole or ziprasidone

Roffeei SN, Reynolds GP, Zainal NZ, Said MA, Hatim A, Aida SA, et al.

Hum Psychopharmacol, 2014 Jan;29(1):38-45.
PMID: 24424705 DOI: 10.1002/hup.2366

Various genetic polymorphisms have been reported to be associated with antipsychotic-induced weight gain. In this study, we aimed to determine whether risk polymorphisms in 12 candidate genes are associated with reduction in body mass index (BMI) of patients following switching of antipsychotics to aripiprazole or ziprasidone.
Modeling of nitrate concentration in groundwater using artificial intelligence approach--a case study of Gaza coastal aquifer

Alagha JS, Said MA, Mogheir Y

Environ Monit Assess, 2014 Jan;186(1):35-45.
PMID: 23974533 DOI: 10.1007/s10661-013-3353-6

Nitrate concentration in groundwater is influenced by complex and interrelated variables, leading to great difficulty during the modeling process. The objectives of this study are (1) to evaluate the performance of two artificial intelligence (AI) techniques, namely artificial neural networks and support vector machine, in modeling groundwater nitrate concentration using scant input data, as well as (2) to assess the effect of data clustering as a pre-modeling technique on the developed models' performance. The AI models were developed using data from 22 municipal wells of the Gaza coastal aquifer in Palestine from 2000 to 2010. Results indicated high simulation performance, with the correlation coefficient and the mean average percentage error of the best model reaching 0.996 and 7 %, respectively. The variables that strongly influenced groundwater nitrate concentration were previous nitrate concentration, groundwater recharge, and on-ground nitrogen load of each land use land cover category in the well's vicinity. The results also demonstrated the merit of performing clustering of input data prior to the application of AI models. With their high performance and simplicity, the developed AI models can be effectively utilized to assess the effects of future management scenarios on groundwater nitrate concentration, leading to more reasonable groundwater resources management and decision-making.
The risk and associated factors of methamphetamine psychosis in methamphetamine-dependent patients in Malaysia

Sulaiman AH, Said MA, Habil MH, Rashid R, Siddiq A, Guan NC, et al.

Compr Psychiatry, 2014 Jan;55 Suppl 1:S89-94.
PMID: 23433219 DOI: 10.1016/j.comppsych.2013.01.003

The objective of this study was to determine the risk of lifetime and current methamphetamine-induced psychosis in patients with methamphetamine dependence. The association between psychiatric co-morbidity and methamphetamine-induced psychosis was also studied.
Association of FTO, LEPR and MTHFR gene polymorphisms with metabolic syndrome in schizophrenia patients receiving antipsychotics

Roffeei SN, Mohamed Z, Reynolds GP, Said MA, Hatim A, Mohamed EH, et al.

Pharmacogenomics, 2014 Mar;15(4):477-85.
PMID: 24624915 DOI: 10.2217/pgs.13.220

The occurrence of metabolic syndrome (MS) in schizophrenia patients receiving long-term antipsychotics (APs) contributes to their high mortality rate. We aimed to determine whether genetic polymorphisms of identified candidate genes are associated with MS in our study population.
Fulltext Co-morbid hypertension, diabetes mellitus or dyslipidemia among patients prescribed with second generation antipsychotic: a comparison study between aripiprazole, quetiapine and clozapine based on pharmacy prescription database

Ng CG, Chan PL, Said MA

Malaysian Journal of Psychiatry, 2015;24(2):0-0.
MyJurnal

Introduction: Second generation antipsychotic (SGA) was linked to increased risk of metabolic syndrome. The risk varies between different SGA. We aim to study this risk by examining the co-prescription of antihypertensive, antidiabetic and lipid lowering drugs in patients prescribed with either aripiprazole, quetiapine or clozapine.
Methods: This is a retrospective cohort study based on the prescription records of a teaching hospital. Prescription records between January 1, 2013 and December 31, 2014 for
psychiatric unit were extracted. Patients with at least one prescription of any antipsychotic were included. The odds of antihypertensive, antidiabetic and lipid lowering drugs co-prescription in patients with either aripiprazole, quetiapine or clozapine were calculated.
Results: Of the 1742 study subjects, 88 patients were prescribed with aripiprazole, 175 patients with clozapine and 124 patients with quetiapine. Patients prescribed with quetiapine had
higher odds of co-prescribed with antihypertensive (OR = 1.71, 95% CI = 1.11, 2.63), antidiabetic drugs (OR = 1.81, 95% CI = 1.11, 2.95) and lipid lowering drugs (OR = 1.94, 95% CI = 1.19, 3.16). There were higher odds of co-prescription of antihypertensive (OR = 1.54, 95% CI = 1.05, 2.25), antidiabetic drugs (OR = 1.69, 95% CI = 1.10, 2.59) and lipid lowering drugs
(OR = 1.90, 95% CI = 1.24, 2.91) in patients with clozapine. However, there were no increase odds of co-prescription of the three agents in patients with aripiprazole.
Conclusion: We need to monitor the risk of metabolic syndrome in patients treated with SGA. Aripiprazole has lower risk of metabolic syndrome.
Fulltext Depression and associated factors in patients with type 2 diabetes mellitus

Hashim NA, Ariaratnam S, Salleh MR, Said MA, Sulaiman AH

East Asian Arch Psychiatry, 2016 Jun;26(2):77-82.
PMID: 27377489

OBJECTIVES: To determine the prevalence of major depressive disorder and its association with socio-demographic and clinical factors in patients with type 2 diabetes mellitus.

METHODS: This was a cross-sectional study of patients with type 2 diabetes mellitus who attended the hospital-based primary care clinics at the University Malaya Medical Centre, Kuala Lumpur, Malaysia. The patients were interviewed using the Mini-International Neuropsychiatric Interview to diagnose depression based on the DSM-IV criteria. The socio-demographic and clinical data were obtained by interviewing the patients and subsequently verified against their respective case notes.

RESULTS: A total of 204 patients were recruited. The prevalence of major depressive disorder was 15.7%. Major depressive disorder was significantly associated with younger age of patients (mean ± standard deviation, 57.8 ± 15.1 years, p = 0.04), younger age at diagnosis of diabetes mellitus (46.2 ± 13.0 years, p = 0.01), having secondary education (p = 0.02), and having a history of depression (p = 0.002). Multivariate analysis showed that current age (p = 0.04), duration of diabetes mellitus (p = 0.04), age at diagnosis of diabetes mellitus (p = 0.01), and secondary education (p = 0.01) were significant factors.

CONCLUSIONS: The prevalence of major depressive disorder was high among patients with type 2 diabetes mellitus. Screening of patients with type 2 diabetes mellitus for depression should be performed periodically or routinely, especially in the primary care setting.
Fulltext Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study

Lee KY, Ong TK, Low EV, Liow SY, Anchah L, Hamzah S, et al.

BMJ Open, 2017 05 28;7(5):e014307.
PMID: 28552843 DOI: 10.1136/bmjopen-2016-014307

OBJECTIVES: Limitations in the quality and access of cost data from low-income and middle-income countries constrain the implementation of economic evaluations. With the increasing prevalence of coronary artery disease in Malaysia, cost information is vital for cardiac service expansion. We aim to calculate the hospitalisation cost of percutaneous coronary intervention (PCI), using a data collection method customised to local setting of limited data availability.

DESIGN: This is a cross-sectional costing study from the perspective of healthcare providers, using top-down approach, from January to June 2014. Cost items under each unit of analysis involved in the provision of PCI service were identified, valuated and calculated to produce unit cost estimates.

SETTING: Five public cardiac centres participated. All the centres provide full-fledged cardiology services. They are also the tertiary referral centres of their respective regions.

PARTICIPANTS: The cost was calculated for elective PCI procedure in each centre. PCI conducted for urgent/emergent indication or for patients with shock and haemodynamic instability were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measures of interest were the unit costs at the two units of analysis, namely cardiac ward admission and cardiac catheterisation utilisation, which made up the total hospitalisation cost.

RESULTS: The average hospitalisation cost ranged between RM11 471 (US$3186) and RM14 465 (US$4018). PCI consumables were the dominant cost item at all centres. The centre with daycare establishment recorded the lowest admission cost and total hospitalisation cost.

CONCLUSIONS: Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for the purpose of economic evaluations.

REGISTRATION: Malaysian MOH Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR).

Study site: 5 hospitals (unnamed) of which 1 is a university teaching hospital
Fulltext Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study

Lee KY, Wan Ahmad WA, Low EV, Liau SY, Anchah L, Hamzah S, et al.

PLoS One, 2017;12(9):e0184410.
PMID: 28873473 DOI: 10.1371/journal.pone.0184410

INTRODUCTION: The increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH).
METHODS: This cross-sectional study was conducted from the healthcare providers' perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test.
RESULTS: The mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients' comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost.
CONCLUSIONS: The high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost-saving strategies to ensure sustainable and equitable cardiac service in Malaysia.
Fulltext Prevalence, transitions and factors predicting transition between frailty states among rural community-dwelling older adults in Malaysia

Ahmad NS, Hairi NN, Said MA, Kamaruzzaman SB, Choo WY, Hairi F, et al.

PLoS One, 2018;13(11):e0206445.
PMID: 30395649 DOI: 10.1371/journal.pone.0206445

OBJECTIVES: This study aims to describe the prevalence and transitions of frailty among rural-community dwelling older adults in Malaysia and to analyse factors associated with different states of frailty transition. Frailty was conceptualized using modified Fried phenotype from the Cardiovascular Health Study.
DESIGN: This is a prospective longitudinal study with 12-months follow up among older adults in Malaysia.
SETTING: Kuala Pilah, a district in Negeri Sembilan, which is one of the fourteen states in Malaysia.
PARTICIPANTS: 2,324 community-dwelling older Malaysians aged 60 years and older.
RESULTS: The overall prevalence of frailty in this study was 9.4% (95% CI 7.8-11.2). The prevalence increased at least three-fold with every 10 years of age. This increase was seen higher in women compared to men. Being frail was significantly associated with older age, women, and respondents with a higher number of chronic diseases, poor cognitive function and low socioeconomic status (p<0.05). During the 12-months follow-up, our study showed that the transition towards greater frailty states were more likely (22.9%) than transition toward lesser frailty states (19.9%) while majority (57.2%) remained unchanged. Multivariate logistic regression analysis showed that presence of low physical activity increased the likelihood of worsening transition towards greater frailty states by three times (OR 2.9, 95% CI 2.2-3.7) and lowered the likelihood of transition towards lesser frailty states (OR 0.3, 95% CI 0.2-0.4).
CONCLUSION: Frailty is reported among one in every eleven older adults in this study. The prevalence increased across age groups and was higher among women than men. Frailty possesses a dynamic status due to its potential reversibility. This reversibility makes it a cornerstone to delay frailty progression. Our study noted that physical activity conferred the greatest benefit as a modifiable factor in frailty prevention.
Fulltext Religious Coping, Religiosity, Depression and Anxiety among Medical Students in a Multi-Religious Setting

Francis B, Gill JS, Yit Han N, Petrus CF, Azhar FL, Ahmad Sabki Z, et al.

Int J Environ Res Public Health, 2019 01 17;16(2).
PMID: 30658450 DOI: 10.3390/ijerph16020259

Medical students are vulnerable to depression and anxiety due to the nature of their academic life. This study aimed to determine the prevalence of depressive and anxiety symptoms among medical students and the association between religious coping, religiosity and socio-demographic factors with anxiety and depressive symptoms. A cross sectional design was used for this study. Scales used were the Malay version of the Duke Religious Index (DUREL-M), the Malay version of the Brief Religious Coping Scale (Brief RCOPE) and the Malay version Hospital and Anxiety Depression Scale (HADS-M). 622 students participated in this study. They scored moderately on the organized (mean: 3.51) and non-organized religious (mean: 3.85) subscales of the DUREL, but had high intrinsic religiosity (mean: 12.18). The prevalence of anxiety and depressive symptoms were 4.7% and 17.4% respectively, which is lower than local as well as international data. Islam, negative religious coping and the presence of depressive symptoms were significantly associated with anxiety symptoms. Only the presence of anxiety symptoms was significantly associated with depressive symptoms. Negative religious coping, rather than positive religious coping, has significant association with depressive and anxiety symptoms. Redirecting focus towards negative religious coping is imperative to boost mental health outcomes among medical students.
Fulltext Microwave-Assisted Synthesis of Mono- and Disubstituted 4-Hydroxyacetophenone Derivatives via Mannich Reaction: Synthesis, XRD and HS-Analysis

Aljohani G, Said MA, Lentz D, Basar N, Albar A, Alraqa SY, et al.

Molecules, 2019 Feb 07;24(3).
PMID: 30736403 DOI: 10.3390/molecules24030590

An efficient microwave-assisted one-step synthetic route toward Mannich bases is developed from 4-hydroxyacetophenone and different secondary amines in quantitative yields, via a regioselective substitution reaction. The reaction takes a short time and is non-catalyzed and reproducible on a gram scale. The environmentally benign methodology provides a novel alternative, to the conventional methodologies, for the synthesis of mono- and disubstituted Mannich bases of 4-hydroxyacetophenone. All compounds were well-characterized by FT-IR, ¹H NMR, 13C NMR, and mass spectrometry. The structures of 1-{4-hydroxy-3-[(morpholin-4-yl)methyl]phenyl}ethan-1-one (2a) and 1-{4-hydroxy-3-[(pyrrolidin-1-yl)methyl]phenyl}ethan-1-one (3a) were determined by single crystal X-ray crystallography. Compound 2a and 3a crystallize in monoclinic, P2₁/n, and orthorhombic, Pbca, respectively. The most characteristic features of the molecular structure of 2a is that the morpholine fragment adopts a chair conformation with strong intramolecular hydrogen bonding. Compound 3a exhibits intermolecular hydrogen bonding, too. Furthermore, the computed Hirshfeld surface analysis confirms H-bonds and π⁻π stack interactions obtained by XRD packing analyses.
Fulltext Public perception and attitude towards dengue prevention activity and response to dengue early warning in Malaysia

Zaki R, Roffeei SN, Hii YL, Yahya A, Appannan M, Said MA, et al.

PLoS One, 2019;14(2):e0212497.
PMID: 30818394 DOI: 10.1371/journal.pone.0212497

An early warning system for dengue is meant to predict outbreaks and prevent dengue cases by aiding timely decision making and deployment of interventions. However, only a system which is accepted and utilised by the public would be sustainable in the long run. This study aimed to explore the perception and attitude of the Malaysian public towards a dengue early warning system. The sample consisted of 847 individuals who were 18 years and above and living/working in the Petaling District, an area adjacent to Kuala Lumpur, Malaysia. A questionnaire consisting of personal information and three sub-measures of; i) perception, ii) attitude towards dengue early warning and iii) response towards early warning; was distributed to participants. We found that most of the respondents know about dengue fever (97.1%) and its association with climate factors (90.6%). Most of them wanted to help reduce the number of dengue cases in their area (91.5%). A small percentage of the respondents admitted that they were not willing to be involved in public activities, and 64% of them admitted that they did not check dengue situations or hotspots around their area regularly. Despite the high awareness on the relationship between climate and dengue, about 45% of respondents do not know or are not sure how this can be used to predict dengue. Respondents would like to know more about how climate data can be used to predict a dengue outbreak (92.7%). Providing more information on how climate can influence dengue cases would increase public acceptability and improve response towards climate-based warning system. The most preferred way of communicating early warning was through the television (66.4%). This study shows that the public in Petaling District considers it necessary to have a dengue warning system to be necessary, but more education is required.
Maximum standardized uptake value from quantitative bone single-photon emission computed tomography/computed tomography in differentiating metastatic and degenerative joint disease of the spine in prostate cancer patients

Mohd Rohani MF, Mat Nawi N, Shamim SE, Wan Sohaimi WF, Wan Zainon WMN, Musarudin M, et al.

Ann Nucl Med, 2020 Jan;34(1):39-48.
PMID: 31612417 DOI: 10.1007/s12149-019-01410-4

OBJECTIVE: Qualitative interpretation in bone scan is often complicated by the presence of degenerative joint disease (DJD), especially in the elderly patient. The aim of this study is to compare objectively 99mTc-MDP tracer uptake between DJD and osseous metastases of the spine using semi-quantitative assessment with SPECT SUV.
METHODS: Bone scan with SPECT/CT using 99mTc-MDP was performed in 34 patients diagnosed with prostate carcinoma. SPECT/CT was performed based on our institutional standard guidelines. SUVmax based on body weight in 238 normal vertebrae visualized on SPECT/CT was quantified as baseline. A total of 211 lesions in the spine were identified on bone scan. Lesions were characterized into DJD or bone metastases based on its morphology on low-dose CT. Semi-quantitative evaluation using SUVmax was then performed on 89 DJD and 122 metastatic bone lesions. As most of the bone lesions were small in volume, the effect of partial volume effect (PVE) on SUVmax was also assessed. The corrected SUVmax values were obtained based on the recovery coefficient (RC) method.
RESULTS: The mean SUVmax for normal vertebrae was 7.08 ± 1.97, 12.59 ± 9.01 for DJD and 36.64 ± 24.84 for bone metastases. The SUVmax of bone metastases was significantly greater than DJD (p value
Numerical investigation on the effect of bileaflet mechanical heart valve's implantation tilting angle and aortic root geometry on intermittent regurgitation and platelet activation

Abbas SS, Nasif MS, Al-Waked R, Meor Said MA

Artif Organs, 2020 Feb;44(2):E20-E39.
PMID: 31378963 DOI: 10.1111/aor.13536

Platelet activation induced by shear stresses and non-physiological flow field generated by bileaflet mechanical heart valves (BMHVs) leads to thromboembolism, which can cause fatal consequences. One of the causes of platelet activation could be intermittent regurgitation, which arises due to asynchronous movement and rebound of BMHV leaflets during the valve closing phase. In this numerical study, the effect of intermittent regurgitation on the platelet activation potential of BMHVs was quantified by modeling a BMHV in the straight and anatomic aorta at implantation tilt angles 0°, 5°, 10°, and 20°. A fully implicit Arbitrary Lagrangian-Eulerian-based Fluid-Structure Interaction formulation was adopted with blood modeled as a multiphase, non-Newtonian fluid. Results showed that the intermittent regurgitation and consequently the platelet activation level increases with the increasing implantation tilt of BMHV. For the straight aorta, the leaflet of the 20° tilted BMHV underwent a rebound of approximately 20° after initially closing, whereas the leaflet of the 10°, 5°, and 0° tilted BMHVs underwent a rebound of 8.5°, 3°, and 0°, respectively. For the anatomic aorta, the leaflet of the 20° tilted BMHV underwent a rebound of approximately 24° after initially closing, whereas the leaflet of the 10°, 5°, and 0° tilted BMHVs underwent a rebound of 14°, 10°, and 7°, respectively. For all the implantation orientations of BMHVs, intermittent regurgitation and platelet activation were always higher in the anatomic aorta than in the straight aorta. The study concludes that the pivot axis of BMHV must be implanted parallel to the aortic root's curvature to minimize intermittent regurgitation and platelet activation.
Health literacy research in Malaysia: Health literacy and other aging challenges among Malaysian public employees

Su TT, Bahuri NHA, Said MA

Stud Health Technol Inform, 2020 Jun 25;269:212-219.
PMID: 32593995 DOI: 10.3233/SHTI200034

This report focuses on a study that addresses the role of health literacy in the challenges surrounding aging. The study was conducted among n=533 public employees ages 40 to 60 years old in Johor state, Malaysia. The validated Malay version of World Health Organization Quality of Life Instrument (WHOQOL-BREF) and the Short-Form Health Literacy Instrument (HLS-SF12) were used to assess perceived quality of life and general health literacy respectively. The WHOQOL-BREF comprises 26 items with six outcomes and the HLS-SF12 consists 12 items. This study provides an overview of participant quality of life, which was operationalized as a precondition of active aging. The participants' preconditions related to active aging were worrisome as 28% perceived their quality of life as poor and 34% were dissatisfied with their health. More positively, health literacy was found to be a significant determinant that may enable active aging.

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