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  1. Fulltext Effect of intra-articular hyaluronic injection on postural stability and risk of fall in patients with bilateral knee osteoarthritis
    Khalaj N, Abu Osman NA, Mokhtar AH, George J, Abas WA
    ScientificWorldJournal, 2014;2014:815184.
    PMID: 25136689 DOI: 10.1155/2014/815184
    Knee osteoarthritis is a common cause of disability which influences the quality of life. It is associated with impaired knee joint proprioception, which affects postural stability. Postural stability is critical for mobility and physical activities. Different types of treatment including nonsurgical and surgical are used for knee osteoarthritis. Hyaluronic acid injection is a nonsurgical popular treatment used worldwide. The aim of this study was to demonstrate the effect of hyaluronic acid injections on postural stability in individuals with bilateral knee osteoarthritis. Fifty patients aged between 50 and 70 years with mild and moderate bilateral knee osteoarthritis participated in our study. They were categorized into treatment (n = 25) and control (n = 25) groups. The treatment group received five weekly hyaluronic acid injections for both knees, whereas the control group did not receive any treatment. Postural stability and fall risk were assessed using the Biodex Stability System and clinical "Timed Up and Go" test. All the participants completed the study. The treatment group showed significant decrease in postural stability and fall risk scores after five hyaluronic acid injections. In contrast, the control group showed significant increase. This study illustrated that five intra-articular hyaluronic acid injections could significantly improve postural stability and fall risk in bilateral knee osteoarthritis patients. This trial is registered with: NCT02063373.
  2. Dietary carbohydrate, fiber and sugar and risk of breast cancer according to menopausal status in Malaysia
    Sulaiman S, Shahril MR, Wafa SW, Shaharudin SH, Hussin SN
    Asian Pac J Cancer Prev, 2014;15(14):5959-64.
    PMID: 25081729
    BACKGROUND: Dietary carbohydrate, fiber and sugar intake has been shown to play a role in the etiology of breast cancer, but the findings have been inconsistent and limited to developed countries with higher cancer incidence.

    OBJECTIVE: To examine the association of premenopausal and postmenopausal breast cancer risk with dietary carbohydrate, fiber and sugar intake.

    MATERIALS AND METHODS: This population based case-control study was conducted in Malaysia with 382 breast cancer patients and 382 controls. Food intake pattern was assessed via an interviewer-administered food frequency questionnaire. Logistic regression was used to compute odds ratios (OR) with 95% confidence intervals (CI) and a broad range of potential confounders were included in analysis.

    RESULTS: A significant two fold increased risk of breast cancer among premenopausal (OR Q4 to Q1=1.93, 95%CI: 1.53-2.61, p-trend=0.001) and postmenopausal (OR Q4 to Q1=1.87, 95%CI: 1.03-2.61, p-trend=0.045) women was observed in the highest quartile of sugar. A higher intake of dietary fiber was associated with a significantly lower breast cancer risk among both premenopausal (OR Q4 to Q1=0.31, 95%CI: 0.12-0.79, p-trend=0.009) and postmenopausal (OR Q4 to Q1=0.23, 95%CI: 0.07-0.76, p-trend=0.031) women.

    CONCLUSIONS: Sugar and dietary fiber intake were independently related to pre- and postmenopausal breast cancer risk. However, no association was observed for dietary carbohydrate intake.

  3. Fulltext Essential oil composition and antimicrobial activities of two closely related species, Alpinia mutica Roxb. and Alpinia latilabris Ridl., from Peninsular Malaysia
    Ibrahim H, Sivasothy Y, Syamsir DR, Nagoor NH, Jamil N, Awang K
    ScientificWorldJournal, 2014;2014:430831.
    PMID: 24987733 DOI: 10.1155/2014/430831
    The essential oils obtained by hydrodistillation of the unripe and ripe fruits of Alpinia mutica Roxb. and Alpinia latilabris Ridl. were analysed by capillary GC and GC-MS. The oils were principally monoterpenic in nature. The unripe and ripe fruit oils of A. mutica were characterized by camphor (21.0% and 15.8%), camphene (16.6% and 10.2%), β-pinene (8.6% and 13.5%), and trans,trans-farnesol (8.0% and 11.2%), respectively. The oils of the unripe and ripe fruits were moderately active against Staphylococcus aureus, Bacillus subtilis, Trichophyton mentagrophytes, and Trichophyton rubrum. 1,8-Cineole (34.2% and 35.9%) and β-pinene (20.2% and 19.0%) were the two most abundant components in the unripe and ripe fruit oils of A. latilabris. The oil of the unripe fruits elicits moderate activity against Staphylococcus aureus and Trichophyton mentagrophytes while Candida glabrata was moderately sensitive to the oil of the ripe fruits.
  4. Fulltext Parasitism performance and fitness of Cotesia vestalis (Hymenoptera: Braconidae) infected with Nosema sp. (Microsporidia: Nosematidae): implications in integrated pest management strategy
    Kermani N, Abu Hassan ZA, Suhaimi A, Abuzid I, Ismail NF, Attia M, et al.
    PLoS One, 2014;9(6):e100671.
    PMID: 24968125 DOI: 10.1371/journal.pone.0100671
    The diamondback moth (DBM) Plutella xylostella (L.) has traditionally been managed using synthetic insecticides. However, the increasing resistance of DBM to insecticides offers an impetus to practice integrated pest management (IPM) strategies by exploiting its natural enemies such as pathogens, parasitoids, and predators. Nevertheless, the interactions between pathogens and parasitoids and/or predators might affect the effectiveness of the parasitoids in regulating the host population. Thus, the parasitism rate of Nosema-infected DBM by Cotesia vestalis (Haliday) (Hym., Braconidae) can be negatively influenced by such interactions. In this study, we investigated the effects of Nosema infection in DBM on the parasitism performance of C. vestalis. The results of no-choice test showed that C. vestalis had a higher parasitism rate on non-infected host larvae than on Nosema-treated host larvae. The C. vestalis individuals that emerged from Nosema-infected DBM (F1) and their progeny (F2) had smaller pupae, a decreased rate of emergence, lowered fecundity, and a prolonged development period compared to those of the control group. DBM infection by Nosema sp. also negatively affected the morphometrics of C. vestalis. The eggs of female C. vestalis that developed in Nosema-infected DBM were larger than those of females that developed in non-infected DBM. These detrimental effects on the F1 and F2 generations of C. vestalis might severely impact the effectiveness of combining pathogens and parasitoids as parts of an IPM strategy for DBM control.
  5. Fulltext Comparative study between Dermo, Pelite, and Seal-In X5 liners: effect on patient's satisfaction and perceived problems
    Ali S, Abu Osman NA, Arifin N, Gholizadeh H, Abd Razak NA, Abas WA
    ScientificWorldJournal, 2014;2014:769810.
    PMID: 25184154 DOI: 10.1155/2014/769810
    This study aimed to compare the effect of satisfaction and perceived problems between Pelite, Dermo with shuttle lock, and Seal-In X5 liners on the transtibial amputees.
  6. Effects of season and storage period on accumulation of individual carotenoids in pumpkin flesh (Cucurbita moschata)
    Jaswir I, Shahidan N, Othman R, Has-Yun Hashim YZ, Octavianti F, bin Salleh MN
    J Oleo Sci, 2014;63(8):761-7.
    PMID: 25007748
    Carotenoids are antioxidants with pharmaceutical potential. The major carotenoids important to humans are α-carotene, β-carotene, lycopene, lutein, zeaxanthin, and β-cryptoxanthin. Some of the biological functions and actions of these individual carotenoids are quite similar to each other, whereas others are specific. Besides genotype and location, other environmental effects such as temperature, light, mineral uptake, and pH have been found affect carotenoid development in plant tissues and organs. Therefore, this research investigated the effects of the season and storage periods during postharvest handling on the accumulation of carotenoid in pumpkin. This study shows that long-term storage of pumpkins resulted in the accumulation of lutein and β-carotene with a slight decrease in zeaxanthin. The amounts of β-carotene ranged from 174.583±2.105 mg/100g to 692.871±22.019 mg/100g, lutein from 19.841±9.693 mg/100g to 59.481±1.645 mg/100g, and zeaxanthin from not detected to 2.709±0.118 mg/100g. The pumpkins were collected three times in a year; they differed in that zeaxanthin was present only in the first season, while the amounts of β-carotene and lutein were the highest in the second and third seasons, respectively. By identifying the key factors among the postharvest handling conditions that control specific carotenoid accumulations, a greater understanding of how to enhance the nutritional values of pumpkin and other crops will be gained. Postharvest storage conditions can markedly enhance and influence the levels of zeaxanthin, lutein, and β-carotene in pumpkin. This study describes how the magnitudes of these effects depend on the storage period and season.
  7. Fulltext Applying theory of planned behavior to predict exercise maintenance in sarcopenic elderly
    Ahmad MH, Shahar S, Teng NI, Manaf ZA, Sakian NI, Omar B
    Clin Interv Aging, 2014;9:1551-61.
    PMID: 25258524 DOI: 10.2147/CIA.S60462
    This study aimed to determine the factors associated with exercise behavior based on the theory of planned behavior (TPB) among the sarcopenic elderly people in Cheras, Kuala Lumpur. A total of 65 subjects with mean ages of 67.5±5.2 (men) and 66.1±5.1 (women) years participated in this study. Subjects were divided into two groups: 1) exercise group (n=34; 25 men, nine women); and 2) the control group (n=31; 22 men, nine women). Structural equation modeling, based on TPB components, was applied to determine specific factors that most contribute to and predict actual behavior toward exercise. Based on the TPB's model, attitude (β=0.60) and perceived behavioral control (β=0.24) were the major predictors of intention to exercise among men at the baseline. Among women, the subjective norm (β=0.82) was the major predictor of intention to perform the exercise at the baseline. After 12 weeks, attitude (men's, β=0.68; women's, β=0.24) and subjective norm (men's, β=0.12; women's, β=0.87) were the predictors of the intention to perform the exercise. "Feels healthier with exercise" was the specific factor to improve the intention to perform and to maintain exercise behavior in men (β=0.36) and women (β=0.49). "Not motivated to perform exercise" was the main barrier among men's intention to exercise. The intention to perform the exercise was able to predict actual behavior regarding exercise at the baseline and at 12 weeks of an intervention program. As a conclusion, TPB is a useful model to determine and to predict maintenance of exercise in the sarcopenic elderly.
  8. Fulltext Development of an air pneumatic suspension system for transtibial prostheses
    Pirouzi G, Abu Osman NA, Oshkour AA, Ali S, Gholizadeh H, Abas WA
    Sensors (Basel), 2014;14(9):16754-65.
    PMID: 25207872 DOI: 10.3390/s140916754
    The suspension system and socket fitting of artificial limbs have major roles and vital effects on the comfort, mobility, and satisfaction of amputees. This paper introduces a new pneumatic suspension system that overcomes the drawbacks of current suspension systems in donning and doffing, change in volume during daily activities, and pressure distribution in the socket-stump interface. An air pneumatic suspension system (APSS) for total-contact sockets was designed and developed. Pistoning and pressure distribution in the socket-stump interface were tested for the new APSS. More than 95% of the area between each prosthetic socket and liner was measured using a Tekscan F-Scan pressure measurement which has developed matrix-based pressure sensing systems. The variance in pressure around the stump was 8.76 kPa. APSS exhibits less pressure concentration around the stump, improved pressure distribution, easy donning and doffing, adjustability to remain fitted to the socket during daily activities, and more adaptability to the changes in stump volume. The volume changes were adjusted by utility of air pressure sensor. The vertical displacement point and reliability of suspension were assessed using a photographic method. The optimum pressure in every level of loading weight was 55 kPa, and the maximum displacement was 6 mm when 90 N of weight was loaded.
  9. Fulltext Antiartherosclerotic effects of plant flavonoids
    Salvamani S, Gunasekaran B, Shaharuddin NA, Ahmad SA, Shukor MY
    Biomed Res Int, 2014;2014:480258.
    PMID: 24971331 DOI: 10.1155/2014/480258
    Atherosclerosis is the process of hardening and narrowing the arteries. Atherosclerosis is generally associated with cardiovascular diseases such as strokes, heart attacks, and peripheral vascular diseases. Since the usage of the synthetic drug, statins, leads to various side effects, the plants flavonoids with antiartherosclerotic activity gained much attention and were proven to reduce the risk of atherosclerosis in vitro and in vivo based on different animal models. The flavonoids compounds also exhibit lipid lowering effects and anti-inflammatory and antiatherogenic properties. The future development of flavonoids-based drugs is believed to provide significant effects on atherosclerosis and its related diseases. This paper discusses the antiatherosclerotic effects of selected plant flavonoids such as quercetin, kaempferol, myricetin, rutin, naringenin, catechin, fisetin, and gossypetin.
  10. 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.
  11. Fulltext Role of EEG as biomarker in the early detection and classification of dementia
    Al-Qazzaz NK, Ali SH, Ahmad SA, Chellappan K, Islam MS, Escudero J
    ScientificWorldJournal, 2014;2014:906038.
    PMID: 25093211 DOI: 10.1155/2014/906038
    The early detection and classification of dementia are important clinical support tasks for medical practitioners in customizing patient treatment programs to better manage the development and progression of these diseases. Efforts are being made to diagnose these neurodegenerative disorders in the early stages. Indeed, early diagnosis helps patients to obtain the maximum treatment benefit before significant mental decline occurs. The use of electroencephalogram as a tool for the detection of changes in brain activities and clinical diagnosis is becoming increasingly popular for its capabilities in quantifying changes in brain degeneration in dementia. This paper reviews the role of electroencephalogram as a biomarker based on signal processing to detect dementia in early stages and classify its severity. The review starts with a discussion of dementia types and cognitive spectrum followed by the presentation of the effective preprocessing denoising to eliminate possible artifacts. It continues with a description of feature extraction by using linear and nonlinear techniques, and it ends with a brief explanation of vast variety of separation techniques to classify EEG signals. This paper also provides an idea from the most popular studies that may help in diagnosing dementia in early stages and classifying through electroencephalogram signal processing and analysis.
  12. Fulltext Molecular Cloning and Optimization for High Level Expression of Cold-Adapted Serine Protease from Antarctic Yeast Glaciozyma antarctica PI12
    Alias N, Ahmad Mazian M, Salleh AB, Basri M, Rahman RN
    Enzyme Res, 2014;2014:197938.
    PMID: 25093119 DOI: 10.1155/2014/197938
    Psychrophilic basidiomycete yeast, Glaciozyma antarctica strain PI12, was shown to be a protease-producer. Isolation of the PI12 protease gene from genomic and mRNA sequences allowed determination of 19 exons and 18 introns. Full-length cDNA of PI12 protease gene was amplified by rapid amplification of cDNA ends (RACE) strategy with an open reading frame (ORF) of 2892 bp, coded for 963 amino acids. PI12 protease showed low homology with the subtilisin-like protease from fungus Rhodosporidium toruloides (42% identity) and no homology to other psychrophilic proteases. The gene encoding mature PI12 protease was cloned into Pichia pastoris expression vector, pPIC9, and positioned under the induction of methanol-alcohol oxidase (AOX) promoter. The recombinant PI12 protease was efficiently secreted into the culture medium driven by the Saccharomyces cerevisiae α-factor signal sequence. The highest protease production (28.3 U/ml) was obtained from P. pastoris GS115 host (GpPro2) at 20°C after 72 hours of postinduction time with 0.5% (v/v) of methanol inducer. The expressed protein was detected by SDS-PAGE and activity staining with a molecular weight of 99 kDa.
  13. Contamination of diuron in coastal waters around Malaysian Peninsular
    Ali HR, Arifin MM, Sheikh MA, Shazili NA, Bakari SS, Bachok Z
    Mar Pollut Bull, 2014 Aug 15;85(1):287-91.
    PMID: 24934440 DOI: 10.1016/j.marpolbul.2014.05.049
    The use of antifouling paints to the boats and ships is one among the threats facing coastal resources including coral reefs in recent decades. This study reports the current contamination status of diuron and its behaviour in the coastal waters of Malaysia. The maximum concentration of diuron was 285 ng/L detected at Johor port. All samples from Redang and Bidong coral reef islands were contaminated with diuron. Temporal variation showed relatively high concentrations but no significant difference (P>0.05) during November and January (North-East monsoon) in Klang ports (North, South and West), while higher levels of diuron were detected during April, 2012 (Inter monsoon) in Kemaman, and Johor port. Although no site has shown concentration above maximum permissible concentration (430 ng/L) as restricted by the Dutch Authorities, however, long term exposure studies for environmental relevance levels of diuron around coastal areas should be given a priority in the future.
  14. Fulltext Cognitive impairment and memory dysfunction after a stroke diagnosis: a post-stroke memory assessment
    Al-Qazzaz NK, Ali SH, Ahmad SA, Islam S, Mohamad K
    Neuropsychiatr Dis Treat, 2014;10:1677-91.
    PMID: 25228808 DOI: 10.2147/NDT.S67184
    Cognitive impairment and memory dysfunction following stroke diagnosis are common symptoms that significantly affect the survivors' quality of life. Stroke patients have a high potential to develop dementia within the first year of stroke onset. Currently, efforts are being exerted to assess stroke effects on the brain, particularly in the early stages. Numerous neuropsychological assessments are being used to evaluate and differentiate cognitive impairment and dementia following stroke. This article focuses on the role of available neuropsychological assessments in detection of dementia and memory loss after stroke. This review starts with stroke types and risk factors associated with dementia development, followed by a brief description of stroke diagnosis criteria and the effects of stroke on the brain that lead to cognitive impairment and end with memory loss. This review aims to combine available neuropsychological assessments to develop a post-stroke memory assessment (PSMA) scheme based on the most recognized and available studies. The proposed PSMA is expected to assess different types of memory functionalities that are related to different parts of the brain according to stroke location. An optimal therapeutic program that would help stroke patients enjoy additional years with higher quality of life is presented.
  15. Fulltext Protein engineering of selected residues from conserved sequence regions of a novel Anoxybacillus α-amylase
    Ranjani V, Janeček S, Chai KP, Shahir S, Abdul Rahman RN, Chan KG, et al.
    Sci Rep, 2014 Jul 28;4:5850.
    PMID: 25069018 DOI: 10.1038/srep05850
    The α-amylases from Anoxybacillus species (ASKA and ADTA), Bacillus aquimaris (BaqA) and Geobacillus thermoleovorans (GTA, Pizzo and GtamyII) were proposed as a novel group of the α-amylase family GH13. An ASKA yielding a high percentage of maltose upon its reaction on starch was chosen as a model to study the residues responsible for the biochemical properties. Four residues from conserved sequence regions (CSRs) were thus selected, and the mutants F113V (CSR-I), Y187F and L189I (CSR-II) and A161D (CSR-V) were characterised. Few changes in the optimum reaction temperature and pH were observed for all mutants. Whereas the Y187F (t1/2 43 h) and L189I (t1/2 36 h) mutants had a lower thermostability at 65°C than the native ASKA (t1/2 48 h), the mutants F113V and A161D exhibited an improved t1/2 of 51 h and 53 h, respectively. Among the mutants, only the A161D had a specific activity, k(cat) and k(cat)/K(m) higher (1.23-, 1.17- and 2.88-times, respectively) than the values determined for the ASKA. The replacement of the Ala-161 in the CSR-V with an aspartic acid also caused a significant reduction in the ratio of maltose formed. This finding suggests the Ala-161 may contribute to the high maltose production of the ASKA.
  16. Fulltext Postural stability characteristics of transtibial amputees wearing different prosthetic foot types when standing on various support surfaces
    Arifin N, Abu Osman NA, Ali S, Gholizadeh H, Abas WA
    ScientificWorldJournal, 2014;2014:856279.
    PMID: 25003155 DOI: 10.1155/2014/856279
    This study aimed to evaluate the effects of prosthetic foot types on the postural stability among transtibial amputees when standing on different support surfaces.
  17. Dendritic fibromyxolipoma: a variant of spindle cell lipoma with extensive myxoid change, with cytogenetic evidence
    Wong YP, Chia WK, Low SF, Mohamed-Haflah NH, Sharifah NA
    Pathol. Int., 2014 Jul;64(7):346-51.
    PMID: 25047505 DOI: 10.1111/pin.12176
    Dendritic fibromyxolipoma (DFML), a rare, recently described distinct benign soft tissue tumor, has many clinicopathological features reminiscent of spindle cell lipoma and solitary fibrous tumor with myxoid change. It is distinguished histologically from both entities by the presence of spindle and stellate cells with dendritic cytoplasmic prolongations, prominent myxoid stroma with abundant keloidal collagen and occasional small plexiform vascular proliferation. We describe a case of histologically confirmed DFML of the left shoulder in a 67-year-old male, in which subsequent cytogenetic analysis revealed deletion involving 13q14.3 region in all the tumor cells, typically detected in spindle cell lipoma. In the presence of many clinicopathological similarities between DFML and spindle cell lipoma including chromosomal abnormalities, we postulate that DFML is merely a rare variant of spindle cell lipoma with extensive myxoid degeneration, and may not be considered as a separate entity. The possible differential diagnosis and their distinguishing features are briefly discussed.
  18. Interface stress in socket/residual limb with transtibial prosthetic suspension systems during locomotion on slopes and stairs
    Eshraghi A, Abu Osman NA, Gholizadeh H, Ali S, Abas WA
    Am J Phys Med Rehabil, 2015 Jan;94(1):1-10.
    PMID: 24919079 DOI: 10.1097/PHM.0000000000000134
    This study aimed to compare the effects of different suspension methods on the interface stress inside the prosthetic sockets of transtibial amputees when negotiating ramps and stairs.
  19. Unscrambling the effect of C-terminal tail deletion on the stability of a cold-adapted, organic solvent stable lipase from Staphylococcus epidermidis AT2
    Kamarudin NH, Rahman RN, Ali MS, Leow TC, Basri M, Salleh AB
    Mol Biotechnol, 2014 Aug;56(8):747-57.
    PMID: 24771007 DOI: 10.1007/s12033-014-9753-1
    Terminal moieties of most proteins are long known to be disordered and flexible. To unravel the functional role of these regions on the structural stability and biochemical properties of AT2 lipase, four C-terminal end residues, (Ile-Thr-Arg-Lys) which formed a flexible, short tail-like random-coil segment were targeted for mutation. Swapping of the tail-like region had resulted in an improved crystallizability and anti-aggregation property along with a slight shift of the thermostability profile. The lipolytic activity of mutant (M386) retained by 43 % compared to its wild-type with 18 % of the remaining activity at 45 °C. In silico analysis conducted at 25 and 45 °C was found to be in accordance to the experimental findings in which the RMSD values of M386 were more stable throughout the total trajectory in comparison to its wild-type. Terminal moieties were also observed to exhibit large movement and flexibility as denoted by high RMSF values at both dynamics. Variation in organic solvent stability property was detected in M386 where the lipolytic activity was stimulated in the presence of 25 % (v/v) of DMSO, isopropanol, and diethyl ether. This may be worth due to changes in the surface charge residues at the mutation point which probably involve in protein-solvent interaction.
  20. Fulltext Balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis
    Khalaj N, Abu Osman NA, Mokhtar AH, Mehdikhani M, Wan Abas WA
    PLoS One, 2014;9(3):e92270.
    PMID: 24642715 DOI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC39584
    Balance is essential for mobility and performing activities of daily living. People with knee osteoarthritis display impairment in knee joint proprioception. Thus, the aim of this study was to evaluate balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis. Sixty subjects aged between 50 and 70 years volunteered in this study. They were categorized into three groups which were healthy (n = 20), mild (n = 20) and moderate (n = 20) bilateral knee osteoarthritis groups. Dynamic and static balance and risk of fall were assessed using Biodex Stability System. In addition, Timed Up and Go test was used as a clinical test for balance. Results of this study illustrated that there were significant differences in balance (dynamic and static) and risk of fall between three groups. In addition, the main (most significant) difference was found to be between healthy group and moderate group. Furthermore, on clinical scoring of balance, the "Timed Up and Go" test, all three groups showed significant difference. In conclusion, bilateral knee osteoarthritis impaired the balance and increased the risk of fall, particularly in people with moderate knee osteoarthritis.
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