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Groundwater level forecasting using ensemble coactive neuro-fuzzy inference system

Boo KBW, El-Shafie A, Othman F, Sherif M, Ahmed AN

Sci Total Environ, 2024 Feb 20;912:168760.
PMID: 38013106 DOI: 10.1016/j.scitotenv.2023.168760

A modeling framework utilizing the coactive neuro-fuzzy inference system (CANFIS) has been developed for multi-lead time groundwater level (GWL) forecasting in four different wells located in Texas and Florida, USA. Various model input combinations, including GWL, precipitation, temperature, and surface water level variables, have been derived based on proposed correlation analysis using singular spectrum analysis (SSA) remainders. The models have been trained on data subsets of varying lengths to identify the optimal training data duration. Additionally, we have introduced the bagging ensemble learning method to enhance the performance of the CANFIS model. As part of a comprehensive model evaluation process, the best-performing CANFIS model for each forecasting scenario has undergone uncertainty analysis using bootstrap sampling. Our results reveal that the CANFIS model performs satisfactorily for daily forecasting but leaves room for improvement in monthly forecasting, particularly for two-month and three-month ahead forecasts. Moreover, we have identified several optimal input combinations, highlighting the significance of the temperature variable in monthly forecasting. Furthermore, our findings indicate that additional training data does not necessarily lead to improved performance. The ensemble CANFIS model has demonstrated significant performance enhancement, particularly for monthly forecasting. Finally, the CANFIS model uncertainty analysis has shown satisfactory results for daily forecasting scenarios, while monthly forecasting models exhibit higher uncertainties, particularly during periods with distinctly different GWL fluctuation patterns.
Transformative learning in clinical reasoning: a meta-synthesis in undergraduate primary care medical education

Abdul Rahman NF, Davies N, Suhaimi J, Idris F, Syed Mohamad SN, Park S

Educ Prim Care, 2023 Jul;34(4):211-219.
PMID: 37742228 DOI: 10.1080/14739879.2023.2248070

Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students' clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings' significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development.
Discovery of a novel dual functional phenylpyrazole-styryl hybrid that induces apoptotic and autophagic cell death in bladder cancer cells

Leong SW, Wang J, Okuda KS, Su Q, Zhang Y, Abas F, et al.

Eur J Med Chem, 2023 Apr 20;254:115335.
PMID: 37098306 DOI: 10.1016/j.ejmech.2023.115335

Unpleasant side effects and resistance development remained the Achilles heel of chemotherapy. Since low tumor-selectivity and monotonous effect of chemotherapy are closely related to such bottleneck, targeting tumor-selective multi-functional anticancer agents may be an ideal strategy in the search of new safer drugs. Herein, we report the discovery of compound 21, a nitro-substituted 1,5-diphenyl-3-styryl-1H-pyrazole that possesses dual functional characteristics. The 2D- and 3D-culture-based studies revealed that 21 not only could induce ROS-independent apoptotic and EGFR/AKT/mTOR-mediated autophagic cell deaths in EJ28 cells simultaneously but also has the ability in inducing cell death at both proliferating and quiescent zones of EJ28 spheroids. The molecular modelling analysis showed that 21 possesses EGFR targeting capability as it forms stable interactions in the EGFR active site. Together with its good safety profile in the zebrafish-based model, the present study showed that 21 is promising and may lead to the discovery of tumor-selective multi-functional anti-cancer agents.
Groundwater level forecasting with machine learning models: A review

Boo KBW, El-Shafie A, Othman F, Khan MMH, Birima AH, Ahmed AN

Water Res, 2024 Mar 15;252:121249.
PMID: 38330715 DOI: 10.1016/j.watres.2024.121249

Groundwater, the world's most abundant source of freshwater, is rapidly depleting in many regions due to a variety of factors. Accurate forecasting of groundwater level (GWL) is essential for effective management of this vital resource, but it remains a complex and challenging task. In recent years, there has been a notable increase in the use of machine learning (ML) techniques to model GWL, with many studies reporting exceptional results. In this paper, we present a comprehensive review of 142 relevant articles indexed by the Web of Science from 2017 to 2023, focusing on key ML models, including artificial neural networks (ANN), adaptive neuro-fuzzy inference systems (ANFIS), support vector regression (SVR), evolutionary computing (EC), deep learning (DL), ensemble learning (EN), and hybrid-modeling (HM). We also discussed key modeling concepts such as dataset size, data splitting, input variable selection, forecasting time-step, performance metrics (PM), study zones, and aquifers, highlighting best practices for optimal GWL forecasting with ML. This review provides valuable insights and recommendations for researchers and water management agencies working in the field of groundwater management and hydrology.
A visualized hybrid PCR-LAMP assay for the detection of human Plasmodium species

Lai MY, Ponnampalavanar SSS, Omar SFS, Lau YL

Acta Trop, 2024 Mar;251:107120.
PMID: 38199452 DOI: 10.1016/j.actatropica.2024.107120

Combining the advantages of PCR and LAMP, we described a new technique, namely PCR-LAMP, for malaria diagnosis. The whole process of DNA amplification can be completed in 35 min. This hybrid amplification technique markedly improved the sensitivity of detection compared to the classic single PCR or LAMP assay alone. PCR-LAMP assay had a detection limit of 1 copy/µL for P. knowlesi and P. ovale, 0.1 copy/µL for P. vivax, P. falciparum and P. malariae, respectively. To facilitate the endpoint detection, xylenol orange was added. Positive samples were indicated in orange while negative reactions were violet. The inclusion of xylenol orange into the LAMP reaction mix significantly reduces the post-amplification workload. Without relying on the use of specific instruments, the color changes of the amplicons could be visualized directly through the naked eye. In conclusion, PCR-LAMP poses the potential to be developed as a new malaria molecular diagnosis tool.
Assessment of Evaporative Demand Drought Index for drought analysis in Peninsular Malaysia

Ng CY, Wan Jaafar WZ, Othman F, Lai SH, Mei Y, Juneng L

Sci Total Environ, 2024 Mar 20;917:170249.
PMID: 38278251 DOI: 10.1016/j.scitotenv.2024.170249

An effective drought monitoring tool is essential for the development of timely drought early warning system. This study evaluates Evaporative Demand Drought Index (EDDI) as a drought indicator in measuring spatiotemporal evolution of droughts over Peninsular Malaysia during 1989-2018. The modified Mann-Kendall and Sen's slope tests were performed to detect the presence of monotonic trends in EDDI, Standardized Precipitation Index (SPI), Standardized Precipitation Evapotranspiration Index (SPEI) and their related climate variables. The performance of EDDI in capturing the drought onset, evolutions and demise of historical severe droughts was also compared with SPI and SPEI at multiple timescales. EDDI demonstrates strong spatiotemporal correlations with SPI and SPEI and comparable performance in historical drought events identification. At sub-monthly timescale, 2-week EDDI displays equivalent drought severities and durations for all historical severe droughts corresponding to the monthly EDDI. In the case when rainfall deficits are normalized in an otherwise warm and dry month, EDDI may serve as a great alternative to SPI and SPEI due to it being sensitive to the changes in prevalent atmospheric conditions. Collectively, the results fill in the knowledge gaps on drought evolutions from the evaporative perspective and highlight the efficacy of EDDI as a valuable drought early warning tool for Peninsular Malaysia. Future study should explore the physical mechanisms behind the development of flash drought and the role of evaporation in the drought propagation processes.
Infrared-metabolomics approach in detecting changes in Andrographis paniculata metabolites due to different harvesting ages and times

Yusof NA, Isha A, Ismail IS, Khatib A, Shaari K, Abas F, et al.

J Sci Food Agric, 2015 Sep;95(12):2533-43.
PMID: 25371390 DOI: 10.1002/jsfa.6987

The metabolite changes in three germplasm accessions of Malaysia Andrographis paniculata (Burm. F.) Nees, viz. 11265 (H), 11341 (P) and 11248 (T), due to their different harvesting ages and times were successfully evaluated by attenuated total reflectance (ATR)-Fourier transform infrared (FTIR) spectroscopy and translated through multivariate data analysis of principal component analysis (PCA) and orthogonal partial least square-discriminant analysis (OPLS-DA). This present study revealed the feasibility of ATR-FTIR in detecting the trend changes of the major metabolites - andrographolide and neoandrographolide - functional groups in A. paniculata leaves of different accessions. The harvesting parameter was set at three different ages of 120, 150 and 180 days after transplanting (DAT) and at two different time sessions of morning (7:30-10:30 am) and evening (2:30-5.30 pm).
Fulltext Nasopharyngeal carcinoma in dermatomyositis patients: A 10-year retrospective review in Hospital Selayang, Malaysia

Teoh JW, Yunus RM, Hassan F, Ghazali N, Abidin ZA

Rep Pract Oncol Radiother, 2014 Sep;19(5):332-6.
PMID: 25184058 DOI: 10.1016/j.rpor.2014.02.005

AIM: The objective of our review is to investigate the association between dermatomyositis patients and nasopharyngeal carcinoma (NPC) together with the clinical presentation of the patients and their management in otorhinolaryngology.
BACKGROUND: NPC is a malignant disease with good prognosis on early diagnosis. However, the relationship between the dermatomyositis and NPC and its management is not well defined.
MATERIALS AND METHODS: A 10-year retrospective review of case records of 21 dermatomyositis patients seen in Otorhinolaryngology Department of Hospital Selayang from January 2000 to November 2010.
RESULTS: These patients ranged from 19 to 74 years old and a total of 8 (38%) out of 21 adults with dermatomyositis were detected to have malignancy. Five out of 8 patients had NPC (62.5%). The mean age of patients with NPC and dermatomyositis was 48 years. NPC is diagnosed in 4 out of 5 patients (80%) in the first year of diagnosis of dermatomyositis. The clinical findings of the examination of nasopharynx ranged from hyperemia to exophytic nasopharyngeal mass. Histologically, it is only related to NPC of WHO types II and III.
CONCLUSIONS: There is a strong relationship between dermatomyositis and malignancy, especially NPC. Clinicians should have a high index of suspicion for malignancy in all dermatomyositis patients. Rigid nasoendoscopies and biopsies, serum Epstein-Barr viral capsid IgA antibody and imaging studies are helpful in detecting NPC in dermatomyositis patients.
KEYWORDS: Dermatomyositis; Epstein–Barr viral capsid IgA; Nasopharyngeal carcinoma; Paraneoplastic; WHO histology
Assessment of water quality parameters using multivariate analysis for Klang River basin, Malaysia

Mohamed I, Othman F, Ibrahim AI, Alaa-Eldin ME, Yunus RM

Environ Monit Assess, 2015 Jan;187(1):4182.
PMID: 25433545 DOI: 10.1007/s10661-014-4182-y

This case study uses several univariate and multivariate statistical techniques to evaluate and interpret a water quality data set obtained from the Klang River basin located within the state of Selangor and the Federal Territory of Kuala Lumpur, Malaysia. The river drains an area of 1,288 km(2), from the steep mountain rainforests of the main Central Range along Peninsular Malaysia to the river mouth in Port Klang, into the Straits of Malacca. Water quality was monitored at 20 stations, nine of which are situated along the main river and 11 along six tributaries. Data was collected from 1997 to 2007 for seven parameters used to evaluate the status of the water quality, namely dissolved oxygen, biochemical oxygen demand, chemical oxygen demand, suspended solids, ammoniacal nitrogen, pH, and temperature. The data were first investigated using descriptive statistical tools, followed by two practical multivariate analyses that reduced the data dimensions for better interpretation. The analyses employed were factor analysis and principal component analysis, which explain 60 and 81.6% of the total variation in the data, respectively. We found that the resulting latent variables from the factor analysis are interpretable and beneficial for describing the water quality in the Klang River. This study presents the usefulness of several statistical methods in evaluating and interpreting water quality data for the purpose of monitoring the effectiveness of water resource management. The results should provide more straightforward data interpretation as well as valuable insight for managers to conceive optimum action plans for controlling pollution in river water.
Fulltext Ultrasound-assisted extraction of antioxidants in Misai Kucing (Orthosiphon stamineus)

Ho SK, Tan CP, Thoo YY, Abas F, Ho CW

Molecules, 2014 Aug 19;19(8):12640-59.
PMID: 25153876 DOI: 10.3390/molecules190812640

Ultrasound-assisted extraction (UAE) with ethanol was used to extract the compounds responsible for the antioxidant activities of Misai Kucing (Orthosiphon stamineus). Response surface methodology (RSM) was used to optimize four independent variables: ethanol concentration (%), amplitude (%), duty cycle (W/s) and extraction time (min). Antioxidant compounds were determined by total phenolic content and total flavonoid content to be 1.4 g gallic acid equivalent/100 g DW and 45 g catechin equivalent/100 g DW, respectively. Antioxidant activities were evaluated using the 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS•+) radical scavenging capacity assay and the 2,2-diphenyl-1-picrylhydrazyl (DPPH•) radical scavenging capacity assay to be 1,961.3 and 2,423.3 µmol Trolox Equivalent Antioxidant Capacity (TEAC)/100 g DW, respectively. Based on the optimal conditions, experimental values were reported to be close to the predicted value by RSM modeling (p>0.05), indicating the suitability of UAE for extracting the antioxidants of Misai Kucing. Rosmarinic acid, kaempferol-rutinoside and sinesetine were identified by high performance liquid chromatography-mass spectrometry.
Fulltext Assessment of extraction parameters on antioxidant capacity, polyphenol content, epigallocatechin gallate (EGCG), epicatechin gallate (ECG) and iriflophenone 3-C-β-glucoside of agarwood (Aquilaria crassna) young leaves

Tay PY, Tan CP, Abas F, Yim HS, Ho CW

Molecules, 2014 Aug 14;19(8):12304-19.
PMID: 25153858 DOI: 10.3390/molecules190812304

The effects of ethanol concentration (0%-100%, v/v), solid-to-solvent ratio (1:10-1:60, w/v) and extraction time (30-180 min) on the extraction of polyphenols from agarwood (Aquilaria crassna) were examined. Total phenolic content (TPC), total flavonoid content (TFC) and total flavanol (TF) assays and HPLC-DAD were used for the determination and quantification of polyphenols, flavanol gallates (epigallocatechin gallate--EGCG and epicatechin gallate--ECG) and a benzophenone (iriflophenone 3-C-β-glucoside) from the crude polyphenol extract (CPE) of A. crassna. 2,2'-Diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity was used to evaluate the antioxidant capacity of the CPE. Experimental results concluded that ethanol concentration and solid-to-solvent ratio had significant effects (p<0.05) on the yields of polyphenol and antioxidant capacity. Extraction time had an insignificant influence on the recovery of EGCG, ECG and iriflophenone 3-C-β-glucoside, as well as radical scavenging capacity from the CPE. The extraction parameters that exhibited maximum yields were 40% (v/v) ethanol, 1:60 (w/v) for 30 min where the TPC, TFC, TF, DPPH, EGCG, ECG and iriflophenone 3-C-β-glucoside levels achieved were 183.5 mg GAE/g DW, 249.0 mg QE/g DW, 4.9 mg CE/g DW, 93.7%, 29.1 mg EGCG/g DW, 44.3 mg ECG/g DW and 39.9 mg iriflophenone 3-C-β-glucoside/g DW respectively. The IC50 of the CPE was 24.6 mg/L.
Fulltext The Curcumin Analogue 1,5-Bis(2-hydroxyphenyl)-1,4-pentadiene-3-one Induces Apoptosis and Downregulates E6 and E7 Oncogene Expression in HPV16 and HPV18-Infected Cervical Cancer Cells

Paulraj F, Abas F, Lajis NH, Othman I, Hassan SS, Naidu R

Molecules, 2015;20(7):11830-60.
PMID: 26132907 DOI: 10.3390/molecules200711830

In an effort to study curcumin analogues as an alternative to improve the therapeutic efficacy of curcumin, we screened the cytotoxic potential of four diarylpentanoids using the HeLa and CaSki cervical cancer cell lines. Determination of their EC50 values indicated relatively higher potency of 1,5-bis(2-hydroxyphenyl)-1,4-pentadiene-3-one (MS17, 1.03 ± 0.5 μM; 2.6 ± 0.9 μM) and 1,5-bis(4-hydroxy-3-methoxyphenyl)-1,4-pentadiene-3-one (MS13, 2.8 ± 0.4; 6.7 ± 2.4 μM) in CaSki and HeLa, respectively, with significantly greater growth inhibition at 48 and 72 h of treatment compared to the other analogues or curcumin. Based on cytotoxic and anti-proliferative activity, MS17 was selected for comprehensive apoptotic studies. At 24 h of treatment, fluorescence microscopy detected that MS17-exposed cells exhibited significant morphological changes consistent with apoptosis, corroborated by an increase in nucleosomal enrichment due to DNA fragmentation in HeLa and CaSki cells and activation of caspase-3 activity in CaSki cells. Quantitative real-time PCR also detected significant down-regulation of HPV18- and HPV16-associated E6 and E7 oncogene expression following treatment. The overall data suggests that MS17 treatment has cytotoxic, anti-proliferative and apoptosis-inducing potential in HPV-positive cervical cancer cells. Furthermore, its role in down-regulation of HPV-associated oncogenes responsible for cancer progression merits further investigation into its chemotherapeutic role for cervical cancer.
Fulltext Metastatic Adenocarcinoma Presenting as Extensive Cavoatrial Tumor Thrombus

Johari B, Abdul Aziz YF, Krishnasamy S, Looi LM, Hashim SA, Raja Mokhtar RA

Iran J Radiol, 2015 Apr;12(2):e11197.
PMID: 26060549 DOI: 10.5812/iranjradiol.11197

The presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (IVC) or supradiaphragmatic carcinoma into the superior vena cava (SVC). Right atrial tumor thrombus with extension into both SVC and IVC has not been reported in the literature. We present a patient who presented with symptoms of right atrial and SVC obstruction. Imaging revealed presence of a thrombus in the right atrium, extending to the SVC and IVC, with the additional findings of a left adrenal mass and multiple liver lesions. The histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. The patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. The clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. This case highlights that in patients manifesting with extensive cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.
Fulltext Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome

Lum LC, Syed Omar SF, Sri La Sri Ponnampalavanar S, Tan LH, Sekaran SD, Kamarulzaman A

PLoS Negl Trop Dis, 2015 Jun;9(6):e0003836.
PMID: 26047325 DOI: 10.1371/journal.pntd.0003836

INTRODUCTION: The increasing incidence of dengue among adults in Malaysia and other countries has important implications for health services. Before 2004, in order to cope with the surge in adult dengue admissions, each of the six medical wards in a university hospital took turns daily to admit and manage patients with dengue. Despite regular in-house training, the implementation of the WHO 1997 dengue case management guidelines by the multiple medical teams was piecemeal and resulted in high variability of care. A restructuring of adult dengue inpatient service in 2004 resulted in all patients being admitted to one ward under the care of the infectious disease unit. Hospital and Intensive Care Unit admission criteria, discharge criteria and clinical laboratory testing were maintained unchanged throughout the study period.
OBJECTIVES: To evaluate the impact of cohorting adult dengue patients on the quality of care and the clinical outcome in a university hospital in Malaysia.
METHODS: A pre (2003) and post-intervention (2005-6) retrospective study was undertaken.
INTERVENTION: Cohorting all dengue patients under the care of the Infectious Disease team in a designated ward in 2004.
RESULTS: The number of patients enrolled was 352 in 2003, 785 in 2005 and 1158 in 2006. The evaluation and detection of haemorrhage remained high (>90%) and unchanged throughout the study period. The evaluation of plasma leakage increased from 35.4% pre-intervention to 78.8% post-intervention (p = <0.001) while its detection increased from 11.4% to 41.6% (p = <0.001). Examination for peripheral perfusion was undertaken in only 13.1% of patients pre-intervention, with a significant increase post-intervention, 18.6% and 34.2% respectively, p = <0.001. Pre-intervention, more patients had hypotension (21.5%) than detected peripheral hypoperfusion (11.4%), indicating that clinicians recognised shock only when patients developed hypotension. In contrast, post-intervention, clinicians recognised peripheral hypoperfusion as an early sign of shock. The highest haematocrit was significantly higher post-intervention but the lowest total white cell counts and platelet counts remained unchanged. A significant and progressive reduction in the use of platelet transfusions occurred, from 21.7% pre-intervention to 14.6% in 2005 and 5.2% in 2006 post-intervention, p<0.001. Likewise, the use of plasma transfusion decreased significantly from 6.1% pre-intervention to 4.0% and 1.6% in the post-intervention years of 2005 and 2006 respectively, p<0.001. The duration of intravenous fluid therapy decreased from 3 days pre-intervention to 2.5 days (p<0.001) post-intervention; the length of hospital stay reduced from 4 days pre- to 3 days (p<0.001) post-intervention and the rate of intensive care admission from 5.8% pre to 2.6% and 2.5% post-intervention, p = 0.005.
CONCLUSION: Cohorting adult dengue patients under a dedicated and trained team of doctors and nurses led to a substantial improvement in quality of care and clinical outcome.
Fulltext Multimodality imaging of left circumflex artery to coronary sinus fistula

Sze TL, Abdul Aziz YF, Abu Bakar N, Mohd Sani F, Oemar H

Iran J Radiol, 2015 Jan;12(1):e6878.
PMID: 25793089 DOI: 10.5812/iranjradiol.6878

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. Patients with this condition are usually asymptomatic. However, cardiac failure may occur later in life due to progressive enlargement of the fistula. Diagnosis is traditionally made by echocardiogram and conventional angiogram. However with the advantage of new technologies such as computed tomography (CT) coronary angiography, the course and communications of these fistulae can be delineated non-invasively and with greater accuracy. We report a case of a left circumflex artery fistula to the coronary sinus which was suspected on echocardiogram and the diagnosis was clinched on ECG-gated CT.
Physicians' knowledge, perceptions and behaviour towards antibiotic prescribing: a systematic review of the literature

Md Rezal RS, Hassali MA, Alrasheedy AA, Saleem F, Md Yusof FA, Godman B

Expert Rev Anti Infect Ther, 2015 May;13(5):665-80.
PMID: 25813839 DOI: 10.1586/14787210.2015.1025057

BACKGROUND: Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. The aim of this paper is to systematically review this.
METHOD: An extensive literature search from 1990 to 2014.
RESULTS: Nineteen articles were included; eight in ambulatory care, seven in hospital settings and four in both, across all countries. Physicians still have inadequate knowledge and misconceptions about antibiotic prescribing. Moreover, some physicians, although aware that antibiotics are of limited benefit in some conditions, still prescribed them. Several factors influenced prescribing, including patients' expectations, severity and duration of infections, uncertainty over diagnosis, potentially losing patients and influence of pharmaceutical companies. Pocket-sized guidelines seen as an important source of information for physicians.
CONCLUSION: Inadequate knowledge of prescribing is prevalent among physicians. However, many physicians were interested in improving their antibiotic prescribing. Multifaceted interventions targeting all key stakeholders, including patients, are needed to improve future antibiotic prescribing.
KEYWORDS: antibiotics; irrational use of medicines; patients; physicians; prescribing behaviour; resistance; systematic reviews
Relationship Between Metabolites Composition and Biological Activities of Phyllanthus niruri Extracts Prepared by Different Drying Methods and Solvents Extraction

Mediani A, Abas F, Khatib A, Tan CP, Ismail IS, Shaari K, et al.

Plant Foods Hum Nutr, 2015 Jun;70(2):184-92.
PMID: 25800644 DOI: 10.1007/s11130-015-0478-5

The study investigated the changes in the metabolite, antioxidant and α-glucosidase inhibitory activities of Phyllanthus niruri after three drying treatments: air, freeze and oven dryings. Water extracts and extracts obtained using different solvent ratios of ethanol and methanol (50, 70, 80 and 100%) were compared. The relationships among the antioxidant, α-glucosidase inhibitory activity and metabolite levels of the extracts were evaluated using partial least-square analysis (PLS). The solvent selectivity was assessed based on the phytochemical constituents present in the extract and their concentrations quantitatively analyzed using high performance liquid chromatography. The freeze-dried P. niruri samples that were extracted with the mixture of ethanol or methanol with low ratio of water showed higher biological activity values compared with the other extracts. The PLS results for the ethanolic with different ratio and water extracts demonstrated that phenolic acids (chlorogenic acid and ellagic acid) and flavonoids were highly linked to strong α-glucosidase inhibitory and antioxidant activities.
Fulltext 2013 dengue outbreaks in Singapore and Malaysia caused by different viral strains

Ng LC, Chem YK, Koo C, Mudin RNB, Amin FM, Lee KS, et al.

Am J Trop Med Hyg, 2015 Jun;92(6):1150-1155.
PMID: 25846296 DOI: 10.4269/ajtmh.14-0588

Characterization of 14,079 circulating dengue viruses in a cross-border surveillance program, UNITEDengue, revealed that the 2013 outbreaks in Singapore and Malaysia were associated with replacement of predominant serotype. While the predominant virus in Singapore switched from DENV2 to DENV1, DENV2 became predominant in neighboring Malaysia. Dominance of DENV2 was most evident on the southern states where higher fatality rates were observed.
Fulltext Students' performance in the different clinical skills assessed in OSCE: what does it reveal?

Sim JH, Abdul Aziz YF, Mansor A, Vijayananthan A, Foong CC, Vadivelu J

Med Educ Online, 2015;20:26185.
PMID: 25697602 DOI: 10.3402/meo.v20.26185

INTRODUCTION: The purpose of this study was to compare students' performance in the different clinical skills (CSs) assessed in the objective structured clinical examination.
METHODS: Data for this study were obtained from final year medical students' exit examination (n=185). Retrospective analysis of data was conducted using SPSS. Means for the six CSs assessed across the 16 stations were computed and compared.
RESULTS: Means for history taking, physical examination, communication skills, clinical reasoning skills (CRSs), procedural skills (PSs), and professionalism were 6.25±1.29, 6.39±1.36, 6.34±0.98, 5.86±0.99, 6.59±1.08, and 6.28±1.02, respectively. Repeated measures ANOVA showed there was a significant difference in the means of the six CSs assessed [F(2.980, 548.332)=20.253, p<0.001]. Pairwise multiple comparisons revealed significant differences between the means of the eight pairs of CSs assessed, at p<0.05.
CONCLUSIONS: CRSs appeared to be the weakest while PSs were the strongest, among the six CSs assessed. Students' unsatisfactory performance in CRS needs to be addressed as CRS is one of the core competencies in medical education and a critical skill to be acquired by medical students before entering the workplace. Despite its challenges, students must learn the skills of clinical reasoning, while clinical teachers should facilitate the clinical reasoning process and guide students' clinical reasoning development.
Fulltext Bioassay-guided fractionation of Melastoma malabathricum Linn. leaf solid phase extraction fraction and its anticoagulant activity

Khoo LT, Abdullah JO, Abas F, Tohit ER, Hamid M

Molecules, 2015 Feb 24;20(3):3697-715.
PMID: 25719740 DOI: 10.3390/molecules20033697

The aims of this study were to examine the bioactive component(s) responsible for the anticoagulant activity of M. malabathricum Linn. leaf hot water crude extract via bioassay-guided fractionation and to evaluate the effect of bioactive component(s) on the intrinsic blood coagulation pathway. The active anticoagulant fraction of F3 was subjected to a series of chromatographic separation and spectroscopic analyses. Furthermore, the effect of the bioactive component(s) on the intrinsic blood coagulation pathway was studied through immediate and time incubation mixing studies. Through Activated Partial Thromboplastin Time (APTT) assay-guided fractionation, Subfraction B was considered the most potent anticoagulant fraction. Characterisation of Subfraction B indicated that anticoagulant activity could partly be due to the presence of cinnamic acid and a cinnamic acid derivative. APTT assays for both the immediate and time incubation mixing were corrected back into normal clotting time range (35.4-56.3 s). In conclusion, cinnamic acid and cinnamic acid derivative from Subfraction B were the first such compounds to be discovered from M. malabathricum Linn. leaf hot water crude extract that possess anticoagulant activity. This active anticoagulant Subfraction B prolonged blood clotting time by causing factor(s) deficiency in the intrinsic blood coagulation pathway.

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