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  1. Periodontal treatment needs and workforce requirements: comparisons between the normative and sociodental approaches using different skill mix models
    Ab-Murat N, Sheiham A, Tsakos G, Watt R
    Community Dent Oral Epidemiol, 2015 Apr;43(2):106-15.
    PMID: 25178437 DOI: 10.1111/cdoe.12125
    Assessment of dental treatment needs has predominantly been based on the normative approach, despite its numerous limitations. The sociodental approach is a more rational method of needs assessment as it incorporates broader concepts of health and needs and behavioural propensity. This study compares estimates of periodontal dental treatment needs and workforce requirements for different skill mixes using normative and sociodental approaches among a sample of adults in Malaysia.
    Matched MeSH terms: Middle Aged
  2. Fulltext Reliability, agreement, and validity of digital weighing scale with MatScan in limb load measurement
    Kumar SN, Omar B, Htwe O, Joseph LH, Krishnan J, Jafarzedah Esfehani A, et al.
    J Rehabil Res Dev, 2014;51(4):591-8.
    PMID: 25144172 DOI: 10.1682/JRRD.2013.07.0166
    Limb loading measurements serve as an objective evaluation of asymmetrical weight bearing in the lower limb. Digital weighing scales (DWSs) could be used in clinical settings for measurement of static limb loading. However, ambiguity exists whether limb loading measurements of DWSs are comparable with a standard tool such as MatScan. A cross-sectional study composed of 33 nondisabled participants was conducted to investigate the reliability, agreement, and validity of DWSs with MatScan in static standing. Amounts of weight distribution and plantar pressure on the individual lower limb were measured using two DWSs (A, B) and MatScan during eyes open (EO) and eyes closed (EC) conditions. The results showed that intra- and interrater reliability (3, 1) were excellent (0.94-0.97) within and between DWS A and B. Bland-Altman plot revealed good agreement between DWS and MatScan in EO and EC conditions. The area under the receiver operating characteristic curve was significant and identified as 0.68 (p = 0.01). The measurements obtained with DWSs are valid and in agreement with MatScan measurements. Hence, DWSs could be used interchangeably with MatScan and could provide clinicians an objective measurement of limb loading suitable for clinical settings.
    Matched MeSH terms: Middle Aged
  3. Fulltext Descriptive epidemiology of colorectal cancer in University Malaya Medical Centre, 2001 to 2010
    Magaji BA, Moy FM, Roslani AC, Law CW
    Asian Pac J Cancer Prev, 2014;15(15):6059-64.
    PMID: 25124558
    BACKGROUND: Colorectal cancer is the second most frequent cancer in Malaysia. Nevertheless, there is little information on treatment and outcomes nationally. We aimed to determine the demographic, clinical and treatment characteristics of colorectal cancer patients treated at the University Malaya Medical Centre (UMMC) as part of a larger project on survival and quality of life outcomes.

    MATERIALS AND METHODS: Medical records of 1,212 patients undergoing treatment in UMMC between January 2001 and December 2010 were reviewed. A retrospective-prospective cohort study design was used. Research tools included the National Cancer Patient Registration form. Statistical analysis included means, standard deviations (SD), proportions, chi square, t-test/ ANOVA. P-value significance was set at 0.05.

    RESULTS: The male: female ratio was 1.2:1. The mean age was 62.1 (SD12.4) years. Patients were predominantly Chinese (67%), then Malays (18%), Indians (13%) and others (2%). Malays were younger than Chinese and Indians (mean age 57 versus 62 versus 62 years, p<0.001). More females (56%) had colon cancers compared to males (44%) (p=0.022). Malays (57%) had more rectal cancer compared to Chinese (45%) and Indians (49%) (p=0.004). Dukes' stage data weres available in 67%, with Dukes' C and D accounting for 64%. Stage was not affected by age, gender, ethnicity or tumor site. Treatment modalities included surgery alone (40%), surgery and chemo/radiotherapy 32%, chemo and radiotherapy (8%) and others (20%).

    CONCLUSIONS: Significant ethnic differences in age and site distribution, if verified in population-based settings, would support implementation of preventive measures targeting those with the greatest need, at the right age.
    Matched MeSH terms: Middle Aged
  4. Fulltext Disease progression in Plasmodium knowlesi malaria is linked to variation in invasion gene family members
    Ahmed AM, Pinheiro MM, Divis PC, Siner A, Zainudin R, Wong IT, et al.
    PLoS Negl Trop Dis, 2014 Aug;8(8):e3086.
    PMID: 25121807 DOI: 10.1371/journal.pntd.0003086
    Emerging pathogens undermine initiatives to control the global health impact of infectious diseases. Zoonotic malaria is no exception. Plasmodium knowlesi, a malaria parasite of Southeast Asian macaques, has entered the human population. P. knowlesi, like Plasmodium falciparum, can reach high parasitaemia in human infections, and the World Health Organization guidelines for severe malaria list hyperparasitaemia among the measures of severe malaria in both infections. Not all patients with P. knowlesi infections develop hyperparasitaemia, and it is important to determine why. Between isolate variability in erythrocyte invasion, efficiency seems key. Here we investigate the idea that particular alleles of two P. knowlesi erythrocyte invasion genes, P. knowlesi normocyte binding protein Pknbpxa and Pknbpxb, influence parasitaemia and human disease progression. Pknbpxa and Pknbpxb reference DNA sequences were generated from five geographically and temporally distinct P. knowlesi patient isolates. Polymorphic regions of each gene (approximately 800 bp) were identified by haplotyping 147 patient isolates at each locus. Parasitaemia in the study cohort was associated with markers of disease severity including liver and renal dysfunction, haemoglobin, platelets and lactate, (r = ≥ 0.34, p =  <0.0001 for all). Seventy-five and 51 Pknbpxa and Pknbpxb haplotypes were resolved in 138 (94%) and 134 (92%) patient isolates respectively. The haplotypes formed twelve Pknbpxa and two Pknbpxb allelic groups. Patients infected with parasites with particular Pknbpxa and Pknbpxb alleles within the groups had significantly higher parasitaemia and other markers of disease severity. Our study strongly suggests that P. knowlesi invasion gene variants contribute to parasite virulence. We focused on two invasion genes, and we anticipate that additional virulent loci will be identified in pathogen genome-wide studies. The multiple sustained entries of this diverse pathogen into the human population must give cause for concern to malaria elimination strategists in the Southeast Asian region.
    Matched MeSH terms: Middle Aged
  5. Fulltext Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors
    Lai PS, Wong YY, Low YC, Lau HL, Chin KF, Mahadeva S
    PeerJ, 2014;2:e451.
    PMID: 25024919 DOI: 10.7717/peerj.451
    Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25-75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hospital in Malaysia. Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients' demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI. Main Outcome Measure. Proportion of appropriate IV PPI prescriptions. Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027). Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing through education of medical staff could result in more judicious use of intravenous PPI and dose-optimization.
    Matched MeSH terms: Middle Aged
  6. The value of comparing mortality of Guillain-Barré syndrome across different regions
    Wong AH, Umapathi T, Shahrizaila N, Chan YC, Kokubun N, Fong MK, et al.
    J Neurol Sci, 2014 Sep 15;344(1-2):60-2.
    PMID: 24993467 DOI: 10.1016/j.jns.2014.06.021
    To study the clinical profile of Guillain-Barré syndrome (GBS) patients who died in 4 Asian countries in order to understand factors underlying any variation in mortality.
    Matched MeSH terms: Middle Aged
  7. Fulltext A web-based dietary intervention for people with type 2 diabetes: development, implementation, and evaluation
    Ramadas A, Chan CK, Oldenburg B, Hussien Z, Quek KF
    Int J Behav Med, 2015 Jun;22(3):365-73.
    PMID: 25274015 DOI: 10.1007/s12529-014-9445-z
    BACKGROUND: Diabetes is becoming a very important health issue in rapidly developing nations and there is an urgent need to improve overall diabetes self-management education in these countries. Although e-health is an emerging theme, only a few successful web-based studies on diabetes self-management have been reported.
    PURPOSE: We describe the development, implementation, and process evaluation of an Internet-delivered dietary intervention program (myDIDeA) for diabetic patients in a developing country.
    METHOD: Specific dietary components to be included in the intervention module were first identified through a comprehensive review of literature and guidelines. The lesson plans and the study website were then developed based on the evidence, Transtheoretical Model's Stages of Change and user-centered design approach. Finally, the effectiveness of the website was tested through a randomized-controlled trial to promote dietary change in patients with type 2 diabetes. The participants in the intervention group (n = 66) were given access to myDIDeA for 6 months. Process evaluation in form of intervention adherence and program reception were conducted at post intervention.
    RESULTS: The response rate for the process evaluation was 89%. On average, each participant logged in at least once for each lesson plan and spent almost 12 min on the site. The participants' content satisfaction, acceptability, and usability scores were satisfactory. The primary outcome of the trial, Dietary Knowledge, Attitude, and Behavior score was strongly correlated with content satisfaction (r = 0.826, p 
    Matched MeSH terms: Middle Aged
  8. Fulltext Correlation between nutritional status and comprehensive physical performance measures among older adults with undernourishment in residential institutions
    Singh DK, Manaf ZA, Yusoff NA, Muhammad NA, Phan MF, Shahar S
    Clin Interv Aging, 2014;9:1415-23.
    PMID: 25187701 DOI: 10.2147/CIA.S64997
    The consequences of combined undernourishment and decreased physical performance in older adults are debilitating and increases cost of care. To date, the information regarding the association between nutritional status and physical performance does not provide a complete picture. Most studies used limited or self-reported measures to evaluate physical performance. The objective of this study was to examine the correlation between nutritional status and comprehensive physical performance measures among undernourished older adults who reside in residential institutions.
    Matched MeSH terms: Middle Aged
  9. Fulltext Clinical breast examination as the recommended breast cancer screening modality in a rural community in Malaysia; what are the factors that could enhance its uptake?
    Farid ND, Aziz NA, Al-Sadat N, Jamaludin M, Dahlui M
    PLoS One, 2014;9(9):e106469.
    PMID: 25188003 DOI: 10.1371/journal.pone.0106469
    Breast cancer is the most common cause of deaths and the most frequently diagnosed cancer among women worldwide. This study aimed to determine the prevalence of breast cancer screening, specifically on clinical breast examination, and the predictors of its uptake among women in Malaysia. A cross-sectional study was carried out in five selected districts whereby women aged between 20 to 64 years old, from a total of 1000 households were interviewed. A total of 1192 women responded to the survey of which 53.3% reported had ever done clinical breast examination. Significant associations with clinical breast examination were noted for income and distance from the hospital. These factors should be considered in developing interventions aimed at promoting clinical breast examination. In particular, healthcare providers should be proactive in raising awareness about clinical breast examination among women in Malaysia.
    Matched MeSH terms: Middle Aged
  10. Robotic-assisted thermal ablation of liver tumours
    Abdullah BJ, Yeong CH, Goh KL, Yoong BK, Ho GF, Yim CC, et al.
    Eur Radiol, 2015 Jan;25(1):246-57.
    PMID: 25189152 DOI: 10.1007/s00330-014-3391-7
    OBJECTIVE: This study aimed to assess the technical success, radiation dose, safety and performance level of liver thermal ablation using a computed tomography (CT)-guided robotic positioning system.

    METHODS: Radiofrequency and microwave ablation of liver tumours were performed on 20 patients (40 lesions) with the assistance of a CT-guided robotic positioning system. The accuracy of probe placement, number of readjustments and total radiation dose to each patient were recorded. The performance level was evaluated on a five-point scale (5-1: excellent-poor). The radiation doses were compared against 30 patients with 48 lesions (control) treated without robotic assistance.

    RESULTS: Thermal ablation was successfully completed in 20 patients with 40 lesions and confirmed on multiphasic contrast-enhanced CT. No procedure related complications were noted in this study. The average number of needle readjustment was 0.8 ± 0.8. The total CT dose (DLP) for the entire robotic assisted thermal ablation was 1382 ± 536 mGy.cm, while the CT fluoroscopic dose (DLP) per lesion was 352 ± 228 mGy.cm. There was no statistically significant (p > 0.05) dose reduction found between the robotic-assisted versus the conventional method.

    CONCLUSION: This study revealed that robotic-assisted planning and needle placement appears to be safe, with high accuracy and a comparable radiation dose to patients.

    KEY POINTS: • Clinical experience on liver thermal ablation using CT-guided robotic system is reported. • The technical success, radiation dose, safety and performance level were assessed. • Thermal ablations were successfully performed, with an average performance score of 4.4/5.0. • Robotic-assisted ablation can potentially increase capabilities of less skilled interventional radiologists. • Cost-effectiveness needs to be proven in further studies.

    Matched MeSH terms: Middle Aged
  11. The effect of Dermo and Seal-In X5 prosthetic liners on pressure distributions and reported satisfaction during ramp ambulation in persons with transtibial limb loss
    Ali S, Osman NA, Razak A, Hussain S, Wan Abas WA
    Eur J Phys Rehabil Med, 2015 Feb;51(1):31-7.
    PMID: 24963603
    Lower limb amputee's are greatly affected in dealing with the environmental barriers such as ramps and stairs and reported high interface pressure between the residual limb and socket/liner. Interface pressure between the residual limb and socket/liner can affect the satisfaction and use of the prosthesis. Until now, little attention has been paid to interface pressure between socket and stump during ramp negotiation and its effect on amputee's satisfaction.
    Matched MeSH terms: Middle Aged
  12. Nasal vestibule schwannoma: report of a rare case
    Fadzilah I, Salina H, Khairuzzana B, Rahmat O, Primuharsa Putra SH
    Ear Nose Throat J, 2014 Jun;93(6):E33-5.
    PMID: 24932827
    Schwannomas of the nasal cavity and paranasal sinuses are quite rare, especially in the nasal vestibule. We report the case of a 61-year-old woman who presented with a 2-month history of progressively worsening right-sided epistaxis and nasal blockage. Rigid nasoendoscopy showed a mobile, smooth, globular mass occupying the right nasal vestibule. The mass arose from the lateral nasal wall and impinged on the anterior part of the middle turbinate posteriorly. Computed tomography of the paranasal sinuses showed a 3.8 × 1.7-cm enhancing mass in the right nostril. The mass obliterated the nasal cavity and caused mild deviation of the septum. The preoperative histopathologic examination showed positivity for vimentin and S-100 protein, suggesting a diagnosis of schwannoma. The patient underwent an intranasal laser-assisted excision biopsy. The histopathologic examination confirmed the diagnosis of schwannoma. Postoperative recovery was uneventful, and no recurrence was seen in the follow-up period.
    Matched MeSH terms: Middle Aged
  13. Use of the CRUSADE bleeding risk score in the prediction of major bleeding for patients with acute coronary syndrome receiving enoxaparin in Thailand
    Jinatongthai P, Khaisombut N, Likittanasombat K, Chaiyakunapruk N, Watcharathanakij S, Nathisuwan S
    Heart Lung Circ, 2014 Nov;23(11):1051-8.
    PMID: 24931064 DOI: 10.1016/j.hlc.2014.05.002
    CRUSADE risk score stands out as a simple-to-use bleeding risk model. However, its use is still doubtful for Thai population. The aim of this study was to assess the prognostic value of CRUSADE in predicting risk of major bleeding among Thai patients with acute coronary syndrome (ACS) receiving enoxaparin.
    Matched MeSH terms: Middle Aged
  14. Report of a rare case of carcinosarcoma of the maxillary sinus with sternal metastasis
    Cheong JP, Rahayu S, Halim A, Khir A, Noorafidah D
    Ear Nose Throat J, 2014 Jun;93(6):E1-4.
    PMID: 24932822
    Carcinosarcoma is a highly aggressive and infiltrative tumor. A finding of this tumor in a paranasal sinus is exceedingly rare. We describe the case of a 61-year-old man who presented with a mass on the left side of his face. The mass was excised via a total maxillectomy with a modified radical neck dissection. Histologic analysis identified a mixture of carcinomatous and sarcomatous components. Within 1 month of surgery, the patient developed a sternal metastasis, and he died within a short period of time. The aggressive nature of this tumor and its metastases demand early diagnosis and prompt treatment.
    Matched MeSH terms: Middle Aged
  15. Clinical and electrophysiological characteristics of symmetric polyneuropathy in a cohort of systemic lupus erythematosus patients
    Jasmin R, Sockalingam S, Ramanaidu LP, Goh KJ
    Lupus, 2015 Mar;24(3):248-55.
    PMID: 25253567 DOI: 10.1177/0961203314552115
    OBJECTIVE: Peripheral neuropathy in systemic lupus erythematosus (SLE) is heterogeneous and its commonest pattern is symmetrical polyneuropathy. The aim of this study was to describe the prevalence, clinical and electrophysiological features, disease associations and effects on function and quality of life of polyneuropathy in SLE patients, defined using combined clinical and electrophysiological diagnostic criteria.
    METHODS: Consecutive SLE patients seen at the University of Malaya Medical Centre were included. Patients with medication and other disorders known to cause neuropathy were excluded. Demographic, clinical and laboratory data were obtained using a pre-defined questionnaire. Function and health-related quality of life was assessed using the modified Rankin scale and the SF-36 scores. Nerve conduction studies (NCS) were carried out in both upper and lower limbs. Polyneuropathy was defined as the presence of bilateral clinical symptoms and/or signs and bilateral abnormal NCS parameters.
    RESULTS: Of 150 patients, 23 (15.3%) had polyneuropathy. SLE-related polyneuropathy was mainly characterized by sensory symptoms of numbness/tingling and pain with mild signs of absent ankle reflexes and reduced pain sensation. Function was minimally affected and there were no differences in quality of life scores. NCS abnormalities suggested mild length-dependent axonal neuropathy, primarily in the distal lower limbs. Compared to those without polyneuropathy, SLE-related polyneuropathy patients were significantly older but had no other significant demographic or disease associations.
    CONCLUSIONS: SLE-related polyneuropathy is a chronic, axonal and predominantly sensory neuropathy, associated with older age. Its underlying pathogenetic mechanisms are unknown, although a possibility could be an increased susceptibility of peripheral nerves in SLE patients to effects of aging.
    Matched MeSH terms: Middle Aged
  16. Fulltext Severe Plasmodium falciparum infection mimicking acute myocardial infarction
    Sulaiman H, Ismail MD, Jalalonmuhali M, Atiya N, Ponnampalavanar S
    Malar J, 2014;13:341.
    PMID: 25176417 DOI: 10.1186/1475-2875-13-341
    This case report describes a case of presumed acute myocardial infarction in a returned traveler who was later diagnosed to have severe malaria. Emergency coronary angiography was normal and subsequent peripheral blood film was positive for Plasmodium falciparum.
    Matched MeSH terms: Middle Aged
  17. Novel use of absorb bioresorbable vascular scaffold and STENTYS self-apposing coronary stent for complex saphenous vein grafts intervention
    Yew KL
    Int J Cardiol, 2014 Dec 20;177(3):e184-5.
    PMID: 25156853 DOI: 10.1016/j.ijcard.2014.08.043
    Matched MeSH terms: Middle Aged
  18. Ethnobotanical uses of medicinal plants for respiratory disorders among the inhabitants of Gallies - Abbottabad, Northern Pakistan
    Kayani S, Ahmad M, Zafar M, Sultana S, Khan MP, Ashraf MA, et al.
    J Ethnopharmacol, 2014 Oct 28;156:47-60.
    PMID: 25153021 DOI: 10.1016/j.jep.2014.08.005
    Rich accessibility of medicinal plants in the study area provides low cost health care for respiratory disorders to local communities. This first report survey was commenced with an aim to document ethnic knowledge regarding the use of folk herbal medicine for respiratory diseases among the local communities of Gallies Abbottabad, Northern Pakistan using quantitative ethnobotanical approaches.
    Matched MeSH terms: Middle Aged
  19. Depression and psychosocial correlates of liver transplant candidates: a systematic review
    Mohamed S, Sabki ZA, Zainal NZ
    Asia Pac Psychiatry, 2014 Dec;6(4):447-53.
    PMID: 25132651 DOI: 10.1111/appy.12145
    Liver transplant candidates are vulnerable to develop depression. This paper aims to ascertain the prevalence of depression in liver transplant candidates and its psychosocial factors in a systematic review.
    Matched MeSH terms: Middle Aged
  20. Optimal set of EEG features for emotional state classification and trajectory visualization in Parkinson's disease
    Yuvaraj R, Murugappan M, Ibrahim NM, Sundaraj K, Omar MI, Mohamad K, et al.
    Int J Psychophysiol, 2014 Dec;94(3):482-95.
    PMID: 25109433 DOI: 10.1016/j.ijpsycho.2014.07.014
    In addition to classic motor signs and symptoms, individuals with Parkinson's disease (PD) are characterized by emotional deficits. Ongoing brain activity can be recorded by electroencephalograph (EEG) to discover the links between emotional states and brain activity. This study utilized machine-learning algorithms to categorize emotional states in PD patients compared with healthy controls (HC) using EEG. Twenty non-demented PD patients and 20 healthy age-, gender-, and education level-matched controls viewed happiness, sadness, fear, anger, surprise, and disgust emotional stimuli while fourteen-channel EEG was being recorded. Multimodal stimulus (combination of audio and visual) was used to evoke the emotions. To classify the EEG-based emotional states and visualize the changes of emotional states over time, this paper compares four kinds of EEG features for emotional state classification and proposes an approach to track the trajectory of emotion changes with manifold learning. From the experimental results using our EEG data set, we found that (a) bispectrum feature is superior to other three kinds of features, namely power spectrum, wavelet packet and nonlinear dynamical analysis; (b) higher frequency bands (alpha, beta and gamma) play a more important role in emotion activities than lower frequency bands (delta and theta) in both groups and; (c) the trajectory of emotion changes can be visualized by reducing subject-independent features with manifold learning. This provides a promising way of implementing visualization of patient's emotional state in real time and leads to a practical system for noninvasive assessment of the emotional impairments associated with neurological disorders.
    Matched MeSH terms: Middle Aged
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