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Mental Health and COVID-19: Policies, Guidelines, and Initiatives from the Asia-Pacific Region

Samy AL, Awang Bono S, Tan SL, Low WY

Asia Pac J Public Health, 2021 11;33(8):839-846.
PMID: 34308673 DOI: 10.1177/10105395211025901

The COVID-19 outbreak was declared a pandemic by the World Health Organization in March 2020 due to rapid intercontinental spread and high morbidity and mortality. Globally, the disease has had a major impact on human lives, including health, economic, employment, psychological, and overall well-being. The COVID-19, besides causing respiratory, neurological, and cardiovascular diseases, has had significant impact on mental health. Major mental health disorders, including depression, anxiety, and stress, have risen in parallel with increasing prevalence of COVID-19. Many population groups, including children, the elderly, those with chronic illnesses, and health care workers, have been affected. This review gives an overall assessment of the prevalence of COVID-19-associated psychological morbidity. In countries in the Asia-Pacific region, prevalence of depression ranged between 4.9% and 43.1%, anxiety from 7.0% to 43.0%, and stress from 3.4% to 35.7%. As COVID-19 continues to severely affect the psychosocial well-being of the population at large, countries have developed and revised policies, guidelines, and introduced new initiatives to curb mental health issues among their citizens. In the long run, pre-disaster preparedness is important to alleviate long-term post-pandemic psychiatric morbidity and to develop psychological resilience toward disasters and pandemic, alongside investment for better mental health coverage.
Fulltext Acute Thoracolumbar Myelitis Secondary To Intrathecal Chemotherapy

Cheong XK, Ng CF, Tan HJ, Remli R

J Neurosci Rural Pract, 2021 Oct;12(4):815-816.
PMID: 34737525 DOI: 10.1055/s-0041-1735246
Fulltext Automated knowledge-assisted mitosis cells detection framework in breast histopathology images

Tan XJ, Mustafa N, Mashor MY, Rahman KSA

Math Biosci Eng, 2022 Jan;19(2):1721-1745.
PMID: 35135226 DOI: 10.3934/mbe.2022081

Based on the Nottingham Histopathology Grading (NHG) system, mitosis cells detection is one of the important criteria to determine the grade of breast carcinoma. Mitosis cells detection is a challenging task due to the heterogeneous microenvironment of breast histopathology images. Recognition of complex and inconsistent objects in the medical images could be achieved by incorporating domain knowledge in the field of interest. In this study, the strategies of the histopathologist and domain knowledge approach were used to guide the development of the image processing framework for automated mitosis cells detection in breast histopathology images. The detection framework starts with color normalization and hyperchromatic nucleus segmentation. Then, a knowledge-assisted false positive reduction method is proposed to eliminate the false positive (i.e., non-mitosis cells). This stage aims to minimize the percentage of false positive and thus increase the F1-score. Next, features extraction was performed. The mitosis candidates were classified using a Support Vector Machine (SVM) classifier. For evaluation purposes, the knowledge-assisted detection framework was tested using two datasets: a custom dataset and a publicly available dataset (i.e., MITOS dataset). The proposed knowledge-assisted false positive reduction method was found promising by eliminating at least 87.1% of false positive in both the dataset producing promising results in the F1-score. Experimental results demonstrate that the knowledge-assisted detection framework can achieve promising results in F1-score (custom dataset: 89.1%; MITOS dataset: 88.9%) and outperforms the recent works.
Fulltext Sharing Information on COVID-19: the ethical challenges in the Malaysian setting

Yusof ANM, Muuti MZ, Ariffin LA, Tan MKM

Asian Bioeth Rev, 2020 Sep;12(3):349-361.
PMID: 32837556 DOI: 10.1007/s41649-020-00132-4

The COVID-19 pandemic has raised challenges in dealing with information sharing by the public and the authorities. There are two categories of information sharing on social media that are believed to be potentially problematic and unethical: the sharing of personal information of patients and the sharing of fake news or false information. We present a discussion on how the response to the COVID-19 pandemic in Malaysia can be ethically handled in terms of information sharing. It is recommended that the public should cultivate the basic skills to evaluate information and determine its validity. On the other hand, the authorities should refrain from placing the blame on patients to avoid them from being stigmatized. It is crucial that all parties are aware of their ethical duty to ensure only ethical and valid information gets shared on social media.
A Systemic Review for Ethnopharmacological Studies on Isatis indigotica Fortune: Bioactive Compounds and their Therapeutic Insights

Wong LW, Goh CBS, Tan JBL

Am J Chin Med, 2022 Feb 09.
PMID: 35139772 DOI: 10.1142/S0192415X22500069

Isatis indigotica Fortune is a biennial Chinese woad of the Cruciferae family. It is primarily cultivated in China, where it was a staple in indigo dye manufacture till the end of the 17th century. Today, I. indigotica is used primarily as a therapeutic herb in traditional Chinese medicine (TCM). The medicinal use of the plant is separated into its leaves (Da-Qing-Ye) and roots (Ban-Lan-Gen), whereas its aerial components can be processed into a dried bluish-spruce powder (Qing-Dai), following dehydration for long-term preservation. Over the past several decades, I. indigotica has been generally utilized for its heat-clearing effects and bodily detoxification in TCM, attributed to the presence of several classes of bioactive compounds, including organic acids, alkaloids, terpenoids, and flavonoids, as well as lignans, anthraquinones, glucosides, glucosinolates, sphingolipids, tetrapyrroles, and polysaccharides. This paper aims to delineate I. indigotica from its closely-related species (Isatis tinctoria and Isatis glauca) while highlighting the ethnomedicinal uses of I. indigotica from the perspectives of modern and traditional medicine. A systematic search of PubMed, Embase, PMC, Web of Science, and Google Scholar databases was done for articles on all aspects of the plant, emphasizing those analyzing the bioactivity of constituents of the plant. The various key bioactive compounds of I. indigotica that have been found to exhibit anti-inflammatory, antimicrobial, anticancer, and anti-allergic properties, along with the protective effects against neuronal injury and bone fracture, will be discussed. Collectively, the review hopes to draw attention to the therapeutic potential of I. indigotica not only as a TCM, but also as a potential source of bioactive compounds for disease management and treatment.
Crystal network structure and stability of beeswax-based oleogels with different polyunsaturated fatty acid oils

Han W, Chai X, Liu Y, Xu Y, Tan CP

Food Chem, 2021 Dec 04;381:131745.
PMID: 35124493 DOI: 10.1016/j.foodchem.2021.131745

The effect of different types of oils including camellia oil (CLO), sunflower oil (SFO), corn oil (CO) and linseed oil (LO) on the formation, crystal network structure and mechanical properties of 4%wt beeswax (BW) in oleogel was investigated. BW oleogels containing oils with higher contents of polyunsaturated fatty acids gelled first (1%wt), especially LO with higher contents of linolenic acid rather than CLO with higher contents of monounsaturated fatty acids. In comparison, oils with higher polyunsaturated fatty acid contents exhibited higher Db with more extensive microstructure at different cooling rates, which was related to shorter nucleation induction time of crystal and higher crystallinity. Stronger van der Waals forces were observed in oleogels with higher polyunsaturated fatty acid contents especially for LO oleogel. Rheology also showed that LO oleogel with higher content of linolenic acid had higher crystallinity and lower crystal melting interfacial tension, resulting in the formation of a more stable network structure.
Life satisfaction and strain among informal caregivers of patients with traumatic brain injury in Malaysia

Mazlan M, Ghani SZ, Tan KF, Subramanian P

Disabil Rehabil, 2016;38(22):2198-2205.
PMID: 26731553 DOI: 10.3109/09638288.2015.1123307

Purpose This study aims to determine the life satisfaction and strain on informal caregivers when caring for traumatic brain injury (TBI) patients and to examine the factors predicting the level of strain among the informal caregivers. Method A cross-sectional survey on a purposive sampling was performed in a single centre in Malaysia recruiting caregivers of patients with TBI. Life Satisfaction Questionnaire-9 and Caregiver Strain Index questionnaires were used to ascertain the life satisfaction and strain of caregivers respectively. Relationship between life satisfaction and strain was analysed, together with factors significantly associated with strain. Results A total of 141 caregivers (77.3% women, average age of 46.1 years ±12.8 and mean duration of caregiving of 24.8 months ± 14.3) were included in the analysis. Most caregivers (75%) were satisfied with their lives but more than half claimed to have strain (57%). There was a significant relationship between life satisfaction and strain among the caregivers (p
Fulltext Effects of feeding fat during pregnancy and lactation on growth performance, milk composition and very low density lipoprotein composition in ratstc "density lipoprotein composition in rats"

Loh TC, Foo HL, Abdul Wahab Z, Tan BK

Malays J Nutr, 2002 Sep;8(2):125-35.
PMID: 22692472

The effects of dietary fat during pregnancy and lactation on growth performance of pups, milk composition and very low density lipoprotein composition in rats were studied. A total of 33 dams were used in this study and each litter was adjusted to 8 pups per dam. The dams were fed on high fat (150 g fat/kg diet, HF), medium fat (75 g fat/kg of diet, MF) and low fat (2.5 g fat/kg diet, LF) diets. The body weights of dams increased during pregnancy and decreased after pregnancy. The HF pups had a higher body weight and higher weight gain than those of LF pups. The amount of feed intake of HF dams was significantly higher than LF and MF dams. The HF dams had significantly higher milk fat and water concentrations than LF dams. The milk protein was not significantly different among the treatment groups. All dams showed hypertriacylglycerolaemia in their very low density lipoprotein (VLDL) in late pregnancy. The VLDL-protein concentrations increased during the first week after parturition. The HF dams showed a greater response to the dietary fat than that of LF and MF dams. The findings suggest that addition of fat in the diet during pregnancy and lactation may improve the milk quality through modifying the composition of VLDL contents, leading to better growth of pups.
Fulltext Vitamin A reserve of liver in health and coronary heart disease among ethnic groups in Singapore

Saha N, Ng TB, Tan PY, Wee KP

Br J Nutr, 1988 Nov;60(3):407-12.
PMID: 3219311 DOI: 10.1079/bjn19880112

1. The vitamin A content of human liver tissue was determined in 363 autopsy samples. The sample comprised a total of 181 subjects dying after accidents and 182 dying from coronary heart disease among Singapore ethnic groups of both sexes. 2. The medium vitamin A reserve was 146 mg/kg in accident victims and 141 mg/kg in those who had died of coronary heart disease. Of all the samples 16% contained less than 40 mg/kg, 45% had 100-300 mg/kg, while 9% contained more than 500 mg/kg liver. 3. Among the accident victims, Indians had the lowest median liver vitamin A reserve (118 mg/kg) compared with that in other ethnic groups (137 mg/kg in Chinese, 191 mg/kg in Malays, 155 mg/kg in Caucasians). 4. The ethnic distribution of vitamin A reserve in coronary deaths was similar to that in accident victims. 5. There was no significant difference between the sexes in hepatic vitamin A reserve. 6. The distribution of vitamin A reserve in all the groups was skewed to the right.
Glaucoma severity affects diffusion tensor imaging (DTI) parameters of the optic nerve and optic radiation

Sidek S, Ramli N, Rahmat K, Ramli NM, Abdulrahman F, Tan LK

Eur J Radiol, 2014 Aug;83(8):1437-41.
PMID: 24908588 DOI: 10.1016/j.ejrad.2014.05.014

To evaluate whether MR diffusion tensor imaging (DTI) of the optic nerve and optic radiation in glaucoma patients provides parameters to discriminate between mild and severe glaucoma and to determine whether DTI derived indices correlate with retinal nerve fibre layer (RNFL) thickness.
Fulltext birgHPC: creating instant computing clusters for bioinformatics and molecular dynamics

Chew TH, Joyce-Tan KH, Akma F, Shamsir MS

Bioinformatics, 2011 May 1;27(9):1320-1.
PMID: 21398666 DOI: 10.1093/bioinformatics/btr109

birgHPC, a bootable Linux Live CD has been developed to create high-performance clusters for bioinformatics and molecular dynamics studies using any Local Area Network (LAN)-networked computers. birgHPC features automated hardware and slots detection as well as provides a simple job submission interface. The latest versions of GROMACS, NAMD, mpiBLAST and ClustalW-MPI can be run in parallel by simply booting the birgHPC CD or flash drive from the head node, which immediately positions the rest of the PCs on the network as computing nodes. Thus, a temporary, affordable, scalable and high-performance computing environment can be built by non-computing-based researchers using low-cost commodity hardware.
Fulltext ClicO FS: an interactive web-based service of Circos

Cheong WH, Tan YC, Yap SJ, Ng KP

Bioinformatics, 2015 Nov 15;31(22):3685-7.
PMID: 26227146 DOI: 10.1093/bioinformatics/btv433

: We present ClicO Free Service, an online web-service based on Circos, which provides a user-friendly, interactive web-based interface with configurable features to generate Circos circular plots.
Blood Pressure Variability and Cognitive Function: a Scoping Review

Asmuje NF, Mat S, Myint PK, Tan MP

Curr Hypertens Rep, 2022 10;24(10):375-383.
PMID: 35731334 DOI: 10.1007/s11906-022-01200-w

PURPOSE OF REVIEW: To conduct a scoping review of articles which have evaluated BPV and cognitive function. Articles with keywords, titles or abstracts containing the terms 'cognitive' OR 'cognition' OR 'dementia' AND 'blood pressure variability' were identified from CINAHL, Medline, PMC and Web of Science.
RECENT FINDINGS: Methods of acquisition and analysis of BPV and cognitive measurements and their relationship were extracted from selected articles. Of 656 studies identified, 53 articles were selected. Twenty-five evaluated long-term (LTBPV), nine mid-term (MTBPV), 12 short-term (STBPV) and nine very short-term BPV (VSTBPV) with conflicting findings on the relationship between BPV and cognition. Variations existed in devices, period and procedure for acquisition. The studies also utilized a wide range of methods of BPV calculation. Thirteen cognitive assessment tools were used to measure global cognition or domain functions which were influenced by the population of interest. The interpretation of available studies was hence limited by heterogeneity. There is an urgent need for standardization of BPV assessments to streamline research on BPV and cognition. Future studies should also establish whether BPV could be a potential modifiable risk factor for cognitive decline, as well as a marker for treatment response.
Sleep quality in opioid-naive and opioid-dependent patientson methadone maintenance therapy in Malaysia

Zahari Z, Inrahim MA, Tan SC, Mohamad N, Ismail R

Turk J Med Sci, 2016 Dec 20;46(6):1743-1748.
PMID: 28081321 DOI: 10.3906/sag-1507-132

BACKGROUND/AIM: Sleep disturbances may contribute to poor treatment outcomes in opioid-dependent patients. The extent to which the sleep profiles of opioid-dependent patients differ from those of the general Malaysian population is not documented. This study compared opioid-naive subjects and opioid-dependent patients on methadone maintenance therapy (MMT) in terms of their sleep quality.
MATERIALS AND METHODS: Participants comprised Malay male opioid-naive subjects (n = 159) and opioid-dependent patients (n = 160) from MMT clinics in Kelantan, Malaysia, between March and October 2013. Sleep quality was evaluated using the translated and validated Malay version of the Pittsburgh Sleep Quality Index (PSQI).
RESULTS: The opioid-dependent patients exhibited higher global PSQI scores [adjusted mean (95% CI) = 5.46 (5.02, 5.90)] than the opioid-naive group [4.71 (4.26, 5.15)] [F (1, 313) = 4.77, P = 0.030].
CONCLUSION: This study confirmed the poorer sleep quality among opioid-dependent patients on MMT, as manifested by their higher global PSQI scores. The sleep complaints in this patient population are a factor to consider and, when necessary, sleep evaluation and treatment should be undertaken to improve MMT patients' quality of sleep and overall treatment outcome.
Taste-masked and affordable donepezil hydrochloride orally disintegrating tablet as promising solution for non-compliance in Alzheimer's disease patients

Liew KB, Tan YT, Peh KK

Drug Dev Ind Pharm, 2015 Apr;41(4):583-93.
PMID: 24495273 DOI: 10.3109/03639045.2014.884130

Manufacturing process and superdisintegrants used in orally disintegrating tablet (ODT) formulation are often time discussed. However, the effect of suitable filler for ODT formulation is not explored thoroughly.
Three-ways crossover bioequivalence study of cephalexin in healthy Malay volunteers

Liew KB, Peh KK, Loh GO, Tan YT

Drug Dev Ind Pharm, 2014 Sep;40(9):1156-62.
PMID: 23688276 DOI: 10.3109/03639045.2013.798805

Although the general pharmacokinetics of cephalexin is quite established up-to-date, however, no population-based study on Cephalexin pharmacokinetics profile in Malay population has been reported yet in the literature.
Effect of polymer, plasticizer and filler on orally disintegrating film

Liew KB, Tan YT, Peh KK

Drug Dev Ind Pharm, 2014 Jan;40(1):110-9.
PMID: 23311593 DOI: 10.3109/03639045.2012.749889

Difficulty in swallowing tablets or capsules has been identified as one of the contributing factors to non-compliance of geriatric patients. Although orally disintegrating tablet was designed for fast disintegration in mouth, the fear of taking solid tablets and the risk of choking for certain patient populations still exist.
Solubility of core materials in aqueous polymeric solution effect on microencapsulation of curcumin

Aziz HA, Peh KK, Tan YT

Drug Dev Ind Pharm, 2007 Nov;33(11):1263-72.
PMID: 18058323

Curcumin, the main active constituent of turmeric herb (Curcuma longa L.) have been reported to possess many medicinal values. The application of curcumin in dermatological preparations is limited by their intense yellow color property, which stains the fabric and skin. The objectives of this study were to reduce the color staining effect and enhance the stability of curcumin via microencapsulation using gelatin simple coacervation method. As for curcumin, ethanol and acetone were used as coacervating solvents. Curcumin was dispersed in ethanol while dissolved in acetone. Irrespective of the types of coacervating solvents used, microencapsulation resolved the color-staining problem and enhanced the flow properties and photo-stability of curcumin. Nevertheless, it was found that more spherical curcumin microcapsules with higher yield, higher curcumin loading, and higher entrapment efficiency were obtained with acetone than ethanol. The in vitro release of curcumin after microencapsulation was slightly prolonged. Further evaluation of the effects of solubility of core materials in coacervating solvent or polymeric aqueous solution using six different drug compounds, namely, ketoconazole, ketoprofen, magnesium stearate, pseudoephedrine HCl, diclofenac sodium, and paracetamol, suggested that the solubility of core materials in aqueous polymeric solution determined the successful formation of microcapsules. Microcapsules could only be formed if the core materials were not dissolved in the aqueous polymeric solution while the core materials could either be dissolved or dispersed in the coacervating solvent. In summary, microencapsulation not only circumvents the color-staining problem but also improved the stability and flowability of curcumin. The solubility of core material in aqueous polymeric solution plays a pivotal role in determining the successful formation of microcapsules.
A national survey on the teaching provision of undergraduate geriatric medicine in Malaysia

Sallehuddin H, Tan MP, Blundell A, Gordon A, Masud T

Gerontol Geriatr Educ, 2021 04 26;43(4):456-467.
PMID: 33899702 DOI: 10.1080/02701960.2021.1914027

Malaysia is becoming an aging nation, with 32 medical schools providing 5,000 graduates every year. The extent these graduates have been trained in core concepts in geriatric medicine remains unclear. This work aims to describe the current state of teaching provision on aging and geriatric medicine to the medical undergraduates in Malaysia. A survey was developed by geriatric medicine experts from the Malaysian Society of Geriatric Medicine (MSGM) to review the teaching provision based on the recommended MSGM Undergraduate Geriatric Medicine Curriculum and was sent to all medical schools across the country. The response rate was 50% (16 out of 32 medical schools). Among 16 medical schools, 10 (62.5%) delivered the learning outcomes as part of an integrated curriculum, and five via a mixed geriatric and integrated curriculum at varying degrees of completeness, ranging from 19% to 94%. One particular medical school did not deliver any of the core topics as part of its undergraduate curriculum. It has been identified that the strongest barrier to delivery was lack of expertise, followed by the fact that the topics were not included in the current curriculum. Improvement in teaching provision should be implemented through a concerted effort to adopt a geriatric medical curriculum nationwide, while future research should aim at the interventions taken to address the barriers in its provision.
Cytoprotective Effects of the Tiger's Milk Mushroom Lignosus rhinocerotis (Agaricomycetes) Sclerotia against Oxidative Stress in PC12 Cells

Tan YH, Lim CSY, Wong KH, Sabaratnam V

Int J Med Mushrooms, 2022;24(12):1-17.
PMID: 36374978 DOI: 10.1615/IntJMedMushrooms.2022045352

Lignosus rhinocerotis (Cooke) Ryvarden has been reported to possess numerous pharmacological effects. However, little is known about its potential role in mitigating the detrimental effects of oxidative stress. The present study investigated the cytoprotective effects of L. rhinocerotis extracts against hydrogen peroxide (H2O2)-induced oxidative stress of rat pheochromocytoma (PC12) cells. In the pre-treatment model, PC12 cells were pre-treated with aqueous (LRAQ) or ethanolic (LRET) extracts of L. rhinocerotis for 24 h, followed by 30 μM of H2O2 for 24 h. In the co-treatment model, the cells were incubated with LRAQ or LRET and H2O2 for 2 or 24 h to induce oxidative stress. Cell viability, intracellular reactive oxygen species (ROS) levels, mitochondrial membrane potential (MMP), and apoptotic cells with activated caspase-3/7 were quantified. Additionally, LRET was separated into fractions by chromatographic methods prior to analysis by gas chromatography-mass spectrometry (GCMS). 320 μg/ml aqueous extract showed a significant cytoprotective effect of 70.0 ± 22.4% and 133.92 ± 8.8% in the pre-treatment and co-treatment models, respectively, compared to untreated H2O2-challenged cells. LRAQ also showed a reduction (p < 0.05) in the percentage of depolarized cells of 37.6 ± 0.6% at 640 ug/ml and 53.4 ± 4.5% at 320 ug/ml in the pre-treatment and co-treatment models, respectively, compared to untreated H2O2-challenged cells. LRAQ or LRET showed a reduction (p < 0.01) in caspase 3/7 activity compared to untreated H2O2-challenged cells in the co-treatment model. However, LRAQ or LRET did not reduce excessive ROS formation (p > 0.05). The cytoprotective effects could be attributed to the presence of fatty acids, phenols, phytosterols, and dicarboxylic acids. In conclusion, L. rhinocerotis extracts demonstrated cytoprotective effects against H2O2-induced oxidative stress in an in vitro model, contributing to the maintenance of cellular integrity through the regulation of mitochondrial function and apoptosis.

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