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  1. Maniam G, Mai CW, Zulkefeli M, Dufès C, Tan DM, Fu JY
    Front Pharmacol, 2018;9:1358.
    PMID: 30534071 DOI: 10.3389/fphar.2018.01358
    Plant-derived phytonutrients have emerged as health enhancers. Tocotrienols from the vitamin E family gained high attention in recent years due to their multi-targeted biological properties, including lipid-lowering, neuroprotection, anti-inflammatory, antioxidant, and anticancer effects. Despite well-defined mechanism of action as an anti-cancer agent, their clinical use is hampered by poor pharmacokinetic profile and low oral bioavailability. Delivery systems based on nanotechnology were proven to be advantageous in elevating the delivery of tocotrienols to tumor sites for enhanced efficacy. To date, preclinical development of nanocarriers for tocotrienols include niosomes, lipid nanoemulsions, nanostructured lipid carriers (NLCs) and polymeric nanoparticles. Active targeting was explored via the use of transferrin as targeting ligand in niosomes. In vitro, nanocarriers were shown to enhance the anti-proliferative efficacy and cellular uptake of tocotrienols in cancer cells. In vivo, improved bioavailability of tocotrienols were reported with NLCs while marked tumor regression was observed with transferrin-targeted niosomes. In this review, the advantages and limitations of each nanocarriers were critically analyzed. Furthermore, a number of key challenges were identified including scale-up production, biological barriers, and toxicity profiles. To overcome these challenges, three research opportunities were highlighted based on rapid advancements in the field of nanomedicine. This review aims to provide a wholesome perspective for tocotrienol nanoformulations in cancer therapy directed toward effective clinical translation.
  2. Tan LN, Cheung KW, Philip I, Ong S, Kilby MD
    Fetal Diagn Ther, 2019;45(5):285-294.
    PMID: 30554214 DOI: 10.1159/000494616
    BACKGROUND/PURPOSE: We report a case study of jejunal atresia and the results of a systematic literature review of all reported cases of bowel complications occurring after fetoscopic laser ablation (FLA) for the treatment of twin-to-twin transfusion syndrome (TTTS).

    METHODS: A systematic literature review was performed of bowel complications after FLA for TTTS according to PRISMA guidelines.

    RESULTS: There are 11 published cases of small bowel atresia, 5 cases of necrotising enterocolitis (NEC), and 2 cases with foetal bowel perforations. Recipient twins were more likely to be affected by small bowel atresia (7 recipient and 4 donor cases) and NEC (3 recipient and 2 donor twins). Prenatal ultrasonographic abnormalities were demonstrated in 7 out of 9 cases with bowel atresia and in both cases of bowel perforation. The overall survival rate for neonates with bowel complications after FLA is 72%, but is much lower for co-twins at 22%. The survival rates for jejunoileal atresia and NEC are 91 and 40%, respectively.

    CONCLUSIONS: It is uncertain as to whether these bowel anomalies are due to bowel ischaemia associated with TTTS, the treatment with FLA, or a combination of both. Cases with prenatal abdominal ultrasonographic abnormalities after FLA should have close prenatal and postnatal assessment to detect bowel complications.

  3. Tan KA, Lum SH, Yahya A, Krishnan S, Jalaludin MY, Lee WS
    Singapore Med J, 2019 Jun;60(6):303-308.
    PMID: 30556093 DOI: 10.11622/smedj.2018155
    INTRODUCTION: Endocrine dysfunction due to iron overload secondary to frequent blood transfusions is a common complication in children with transfusion-dependent thalassaemia (TDT). We ascertained the prevalence of endocrine dysfunction in children with TDT seen in a hospital setting in Malaysia.

    METHODS: We reviewed all patients with TDT who had ≥ 8 blood transfusions per year. Patients who had a history of stem cell transplantation, concurrent autoimmune diseases or were newly diagnosed to have TDT were excluded. Standard diagnostic criteria were used in the diagnosis of various endocrine dysfunctions.

    RESULTS: Of the 82 patients with TDT, 65% had at least one endocrine dysfunction. Short stature was the commonest (40.2%), followed by pubertal disorders (14.6%), hypoparathyroidism (12.3%), vitamin D deficiency (10.1%), hypocortisolism (7.3%), diabetes mellitus (5.2%) and overt hypothyroidism (4.9%). Subclinical hypothyroidism and pre-diabetes mellitus were seen in 13.4% and 8.6% of the patients, respectively. For children aged < 10 years, the prevalence of both thyroid dysfunction and hypoparathyroidism was 9.1%.

    CONCLUSION: Two-thirds of children with TDT experienced at least one endocrine dysfunction. Thyroid dysfunction and hypoparathyroidism may be missed if endocrine screening is only performed in children with TDT > 10 years of age. Close monitoring for endocrine dysfunction and hormonal therapy is essential to prevent long-term adverse outcomes.

  4. Bukhsh A, Tan XY, Chan KG, Lee LH, Goh BH, Khan TM
    Patient Prefer Adherence, 2018;12:2457-2474.
    PMID: 30538430 DOI: 10.2147/PPA.S180256
    Background: Effectiveness of pharmacist-led educational interventions on self-care activities and glycemic control of type 2 diabetes mellitus (T2DM) patients is vague. The purpose of this review is to appraise the effect of pharmacist-led educational interventions on self-care activities and levels of glycated hemoglobin of T2DM patients.

    Methods: Five electronic databases were searched from date of database inception to September 2017. Randomized clinical trials examining the effectiveness of pharmacist-led educational interventions, directed at T2DM patients only, were included for systematic review and meta-analysis. The protocol is available with PROSPERO (CRD42017078854).

    Results: Eleven studies, involving n=1,544 T2DM patients, were included in this systematic review. Meta-analysis demonstrated that pharmacist-led interventions had a significant effect on lowering of the levels of glycated hemoglobin (-0.66; 95% CI [-0.83, -0.50]; I2=58.3%; P=0.008), in comparison to usual care. Self-care activities were assessed by using Summary of Diabetes Self-care Activities tool in eight studies. Overall meta-analysis of self-care activities for included studies demonstrated a significant effect of pharmacist-led interventions on improvement of self-monitoring of blood glucose (1.62; 95% CI [0.92, 2.32]; I2=70.5%; P=0.005), foot care (1.20; 95% CI [0.49, 1.90]; I2=95.0%; P<0.001), and overall diet (1.16; 95% CI [0.38, 1.93]; I2=64.2%; P=0.094).

    Conclusion: The findings of this review demonstrate a significantly positive effect of pharmacist-led educational interventions on HbA1c levels and self-care practices among T2DM patients.
  5. Tin TC, Chiew KL, Phang SC, Sze SN, Tan PS
    Comput Intell Neurosci, 2019;2019:8729367.
    PMID: 30719036 DOI: 10.1155/2019/8729367
    Preventive maintenance activities require a tool to be offline for long hour in order to perform the prescribed maintenance activities. Although preventive maintenance is crucial to ensure operational reliability and efficiency of the tool, long hour of preventive maintenance activities increases the cycle time of the semiconductor fabrication foundry (Fab). Therefore, this activity is usually performed when the incoming Work-in-Progress to the equipment is forecasted to be low. The current statistical forecasting approach has low accuracy because it lacks the ability to capture the time-dependent behavior of the Work-in-Progress. In this paper, we present a forecasting model that utilizes machine learning method to forecast the incoming Work-In-Progress. Specifically, our proposed model uses LSTM to forecast multistep ahead incoming Work-in-Progress prediction to an equipment group. The proposed model's prediction results were compared with the results of the current statistical forecasting method of the Fab. The experimental results demonstrated that the proposed model performed better than the statistical forecasting method in both hit rate and Pearson's correlation coefficient, r.
  6. Li S, Li C, Yang Y, He X, Zhang B, Fu X, et al.
    Food Chem, 2019 Jun 15;283:437-444.
    PMID: 30722895 DOI: 10.1016/j.foodchem.2019.01.020
    The present study aimed at investigating the effects of octenylsuccinylation and particle size on the emulsifying properties of starch granules as Pickering emulsifiers. Starch spherulites (1-5 μm), native rice starch (5-10 μm), waxy maize starch (10-20 μm) and waxy potato starch (20-30 μm) were modified with octenylsuccinic anhydride. Results showed that octenylsuccinylation caused a significant increase in the contact angle, and there was a weak positive linear correlation with the emulsifying capacity of the starch granules. After octenylsuccinylation, smaller particles of octenylsuccinate-starch granules exhibited better emulsifying properties with smaller droplet size and lower creaming index. Overall, both octenylsuccinylation and particle size have important effects on the emulsifying properties of starch granules as Pickering stabilizers. This study could be useful in the design and development of starch-based Pickering emulsifiers, and provide potential applications in the food and pharmaceutical industries.
  7. Müller AM, Tan CS, Chu AHY, van Dam RM, Müller-Riemenschneider F
    Int J Public Health, 2019 Jun;64(5):659-668.
    PMID: 30739208 DOI: 10.1007/s00038-019-01203-6
    OBJECTIVES: Examine the association between psychological variables and accelerometer-measured moderate-to-vigorous physical activity (MVPA) in urban Asians.

    METHODS: A population-based cross-sectional study was conducted in Singapore. Participants wore an accelerometer for 7 days to measure physical activity (PA). Demographic, anthropometric and psychological data were also collected. Psychological variables included PA guideline knowledge, motivational profile for PA self-regulation (5 subscales), perceived barriers to PA (4 subscales) and perceived social support for PA. Regression models with adjustment for socio-demographic variables were fitted.

    RESULTS: External regulation (b = - 13.03, 95% CI - 34.55; - 1.50) and perceived daily life barriers (b = - 12.63, 95% CI - 24.95; - 0.32) were significantly associated with fewer weekly MVPA minutes. A significant interaction between perceived social support and age (p = 0.046) was found. Social support was significantly negative associated with MVPA minutes in younger (

  8. Lim JA, Tan WC, Khor BT, Hukam Gopal Chand SD, Palanivelu T
    J Am Coll Clin Wound Spec, 2017;9(1-3):35-38.
    PMID: 30591900 DOI: 10.1016/j.jccw.2018.06.003
    A 72-year-old man presented with a chronic scaly verrucous plaque over his right knee for nine months. The lesion was preceded by a well healed scar sustained five years back from a road traffic accident. He was given multiple courses of systemic antibiotic and antifungal medications but to no avail. A skin biopsy confirmed cutaneous tuberculosis. The area of plaque subsided significantly with antituberculosis treatment. However, during the second month of treatment, a new onset of a red fleshy granulating growth developed on the pre-existing site. A repeat skin biopsy revealed squamous cell carcinoma (SCC). He was subsequently referred for surgical excision. This is presumably the first reported case of SCC arising from tuberculosis verrucosa cutis. While most malignant transformations from tuberculosis has been thought to develop after a long period of time (usually more than twenty-five years), this case report showed that it may also occur within a short period of time. Awareness on this condition is important because any delay in diagnosis and treatment may have detrimental consequences.
  9. Tan M, Mariapun S, Yip CH, Ng KH, Teo SH
    Phys Med Biol, 2019 01 31;64(3):035016.
    PMID: 30577031 DOI: 10.1088/1361-6560/aafabd
    Historically, breast cancer risk prediction models are based on mammographic density measures, which are dichotomous in nature and generally categorize each voxel or area of the breast parenchyma as 'dense' or 'not dense'. Using these conventional methods, the structural patterns or textural components of the breast tissue elements are not considered or ignored entirely. This study presents a novel method to predict breast cancer risk that combines new texture and mammographic density based image features. We performed a comprehensive study of the correlation of 944 new and conventional texture and mammographic density features with breast cancer risk on a cohort of Asian women. We studied 250 breast cancer cases and 250 controls matched at full-field digital mammography (FFDM) status for age, BMI and ethnicity. Stepwise regression analysis identified relevant features to be included in a linear discriminant analysis (LDA) classifier model, trained and tested using a leave-one-out based cross-validation method. The area under the receiver operating characteristic (AUC) and adjusted odds ratios (ORs) were used as the two performance assessment indices in our study. For the LDA trained classifier, the adjusted OR was 6.15 (95% confidence interval: 3.55-10.64) and for Volpara volumetric breast density, 1.10 (0.67-1.81). The AUC for the LDA trained classifier was 0.68 (0.64-0.73), compared to 0.52 (0.47-0.57) for Volpara volumetric breast density (p   
  10. Rusli N, Amanah A, Kaur G, Adenan MI, Sulaiman SF, Wahab HA, et al.
    Naunyn Schmiedebergs Arch Pharmacol, 2019 04;392(4):481-496.
    PMID: 30604191 DOI: 10.1007/s00210-018-01605-y
    Mitragynine is a major component isolated from Mitragyna speciosa Korth or kratom, a medicinal plant known for its opiate-like and euphoric properties. Multiple toxicity and fatal cases involving mitragynine or kratom have been reported but the underlying causes remain unclear. P-glycoprotein (P-gp) is a multidrug transporter which modulates the pharmacokinetics of xenobiotics and plays a key role in mediating drug-drug interactions. This study investigated the effects of mitragynine on P-gp transport activity, mRNA, and protein expression in Caco-2 cells using molecular docking, bidirectional assay, RT-qPCR, Western blot analysis, and immunocytochemistry techniques, respectively. Molecular docking simulation revealed that mitragynine interacts with important residues at the nucleotide binding domain (NBD) site of the P-gp structure but not with the residues from the substrate binding site. This was consistent with subsequent experimental work as mitragynine exhibited low permeability across the cell monolayer but inhibited digoxin transport at 10 μM, similar to quinidine. The reduction of P-gp activity in vitro was further contributed by the downregulation of mRNA and protein expression of P-gp. In summary, mitragynine is likely a P-gp inhibitor in vitro but not a substrate. Hence, concurrent administration of mitragynine-containing kratom products with psychoactive drugs which are P-gp substrates may lead to clinically significant toxicity. Further clinical study to prove this point is needed.
  11. Hudu SA, Niazlin MT, Nordin SA, Tan SS, Omar H, Shahar H, et al.
    Afr Health Sci, 2018 Dec;18(4):1117-1133.
    PMID: 30766578 DOI: 10.4314/ahs.v18i4.33
    Background: Hepatitis B virus co-infection with other strains of viral hepatitis is associated with increased risk of liver cirrhosis and hepatic decompensation.

    Objectives: This is a prevalence study that assessed the genetic diversity of chronic hepatitis B patients and coinfection.

    Methods: Chronic hepatitis B patients enrolled in this study were tested for antibodies of other hepatitis viruses using ELISA kits. Patient clinical profiles were collected and partial genes of HBV, HCV, and HEV were amplified, sequenced, and analyzed using phylogenetic analysis. The associations between variables were determined using the chi-squared test.

    Results: Of the 82 patients recruited for this study, 53.7% were non-cirrhotic, 22.0% cirrhotic, 20.7% acute flare and 3.7% hepatocellular carcinoma. Majority (58%) of patients had a high level of ALT (≥34 U/L). Sequence analysis showed HBV (63.9%) belonged to genotype B, HEV belonged to genotype 4 while HCV belonged to genotype 3a and the genotypes were found to be significantly associated with the clinical stage of the patients (χ2=56.632; p<0.01). Similarly, Hepatitis B e antigen was also found to be significantly associated with the clinical stage of infection (χ2=51.952; p<0.01).

    Conclusion: This study revealed that genetic diversity was found to have a significant impact on the severity of infection.

  12. Tan LT, Chan KG, Pusparajah P, Yin WF, Khan TM, Lee LH, et al.
    BMC Microbiol, 2019 02 13;19(1):38.
    PMID: 30760201 DOI: 10.1186/s12866-019-1409-7
    BACKGROUND: Colon cancer is the third most commonly diagnosed cancer worldwide, with a commensurately high mortality rate. The search for novel antioxidants and specific anticancer agents which may inhibit, delay or reverse the development of colon cancer is thus an area of great interest; Streptomyces bacteria have been demonstrated to be a source of such agents.

    RESULTS: The extract from Streptomyces sp. MUM265- a strain which was isolated and identified from Kuala Selangor mangrove forest, Selangor, Malaysia- was analyzed and found to exhibit antioxidant properties as demonstrated via metal-chelating ability as well as superoxide anion, DPPH and ABTS radical scavenging activities. This study also showed that MUM265 extract demonstrated cytotoxicity against colon cancer cells as evidenced by the reduced cell viability of Caco-2 cell line. Treatment with MUM265 extract induced depolarization of mitochondrial membrane potential and accumulation of subG1 cells in cell cycle analysis, suggesting that MUM265 exerted apoptosis-inducing effects on Caco-2 cells.

    CONCLUSION: These findings indicate that mangrove derived Streptomyces sp. MUM265 represents a valuable bioresource of bioactive compounds for the future development of chemopreventive agents, with particular promise suggested for treatment of colon cancer.

  13. Yunus NA, Mazlan SA, Ubaidillah, Abdul Aziz SA, Tan Shilan S, Abdul Wahab NA
    Int J Mol Sci, 2019 Feb 10;20(3).
    PMID: 30744210 DOI: 10.3390/ijms20030746
    Determination of the thermal characteristics and temperature-dependent rheological properties of the magnetorheological elastomers (MREs) is of paramount importance particularly with regards to MRE applications. Hitherto, a paucity of temperature dependent analysis has been conducted by MRE researchers. In this study, an investigation on the thermal and rheological properties of epoxidized natural rubber (ENR)-based MREs was performed. Various percentages of carbonyl iron particles (CIPs) were blended with the ENR compound using a two roll-mill for the preparation of the ENR-based MRE samples. The morphological, elemental, and thermal analyses were performed before the rheological test. Several characterizations, as well as the effects of the strain amplitude, temperature, and magnetic field on the rheological properties of ENR-based MRE samples, were evaluated. The micrographs and elemental results were well-correlated regarding the CIP and Fe contents, and a uniform distribution of CIPs was achieved. The results of the thermal test indicated that the incorporation of CIPs enhanced the thermal stability of the ENR-based MREs. Based on the rheological analysis, the storage modulus and loss factor were dependent on the CIP content and strain amplitude. The effect of temperature on the rheological properties revealed that the stiffness of the ENR-based MREs was considered stable, and they were appropriate to be employed in the MRE devices exposed to high temperatures above 45 °C.
  14. Sufyan M, Abd Rahim N, Tan C, Muhammad MA, Sheikh Raihan SR
    PLoS One, 2019;14(2):e0211642.
    PMID: 30763331 DOI: 10.1371/journal.pone.0211642
    The incessantly growing demand for electricity in today's world claims an efficient and reliable system of energy supply. Distributed energy resources such as diesel generators, wind energy and solar energy can be combined within a microgrid to provide energy to the consumers in a sustainable manner. In order to ensure more reliable and economical energy supply, battery storage system is integrated within the microgrid. In this article, operating cost of isolated microgrid is reduced by economic scheduling considering the optimal size of the battery. However, deep discharge shortens the lifetime of battery operation. Therefore, the real time battery operation cost is modeled considering the depth of discharge at each time interval. Moreover, the proposed economic scheduling with battery sizing is optimized using firefly algorithm (FA). The efficacy of FA is compared with other metaheuristic techniques in terms of performance measurement indices, which are cost of electricity and loss of power supply probability. The results show that the proposed technique reduces the cost of microgrid and attain optimal size of the battery.
  15. Low, Qin Jian, Lim, Tzyy Hue, Teoh, Kuo Zhau, Siow, Garry Peir Woeei, Go, Zher Lin, Tee, Vern Jun, et al.
    MyJurnal
    Purple urine bag syndrome (PUBS) is a rare presentation of urinary tract infections (UTIs). It is commonly seen in constipated patients. There is a deep purple discoloration of contents of urine bag due to presence of indigo and indirubin pigments which are metabolites of tryptophan. We would like to describe an interesting case of purple urine bag syndrome of 88-year-old woman who presented with catheter-related urinary tract infection. She had low-grade fever and suprapubic discomfort for three days duration. She had increased white cell count and C-reactive peptide (CRP). Urinalysis showed protein 2+, nitrite and leucocyte esterase positive. Urine culture grew Escherichia coli and Klebsiella pneumoniae. She was treated with oral cefuroxime and recovered. This case report may be the first case of PUBS reported in this region.
  16. Al-Fayyadh MZM, Tan HCY, Hui TS, Ali MRBM, Min NW
    J Orthop Surg (Hong Kong), 2019 2 21;27(1):2309499019828552.
    PMID: 30782072 DOI: 10.1177/2309499019828552
    The 'all-inside' meniscus repair is extremely useful technique in addressing tears at the far posterior horn of meniscus. However, this procedure may place the popliteal neurovascular bundle at risk of injury. The purpose of this study was to evaluate the risk of popliteal artery injury by the trajectory of anchor delivery instruments inserted through standard knee arthroscopic portals for the repair of the far posterior horn of meniscus tears. Standard arthroscopic portals were marked on five human cadaveric knees which were subsequently disarticulated. Axial photographs were taken after marking the 5 10, and 15 mm points from the meniscal root on the posterior horns of the menisci. The unsafe zones for meniscus repair at each of these points were identified on the photographs of knees by first drawing two lines from the edges of the popliteal artery and crossing at the respective points at the posterior horns. The points at which these lines meet a circular protractor applied to the center of each meniscus in the knee photograph were recorded as a range. The range signifies the unsafe zone for each respective point on the posterior horn of meniscus. The anterolateral arthroscopic portal fell within the unsafe zone of the 5 mm point on the posterior horn of lateral meniscus in three of the five knees and within the unsafe zone of the 10 mm point on the posterior horn of lateral meniscus in another two knees. A cautious approach should be practiced during the repair of tears located at these two points. None of the other points' unsafe zones (lateral 15 mm, medial 5 mm, 10 mm and 15 mm points) coincided with the ipsilateral portal sites. Level of evidence 5 (Human cadaveric study).
  17. Lim KK, Chan YY, Mahmud NA, Ismail H, Tan BC, Chua BK, et al.
    Int J Public Health Res, 2018;8(2):980-986.
    MyJurnal
    Introduction Iodine deficiency disorders (IDD) during pregnancy may impair the neurological development of the fetus. The aim of this study is to determine the iodine status among pregnant women (PW) in Sarawak after introduction of mandatory universal salt iodisation (USI) for seven years.
    Methods A total of 508 first trimester PW attending government Maternal and Child Health Care clinics in all 11 divisions in Sarawak between 1st April and 15th June 2015 were recruited. Urine samples were obtained and analysed for urinary iodine concentration (UIC) using the modified Sandell-Kolthoff reaction method. For pregnant women, an adequate iodine intake was defined as a median UIC between 150-249 µg/L according to the WHO/UNICEF/ICCIDD’s criterion. For further analyses, the 11 divisions were then combined into 3 regions, namely Northern (Miri, Bintulu, Limbang), Central (Kapit, Mukah, Sibu, Sarikei, Betong) and Southern (Kota Samarahan, Kuching, Sri Aman).
    Results TThe median UIC of the PW in Sarawak was 105.6 µg/L, indicating iodine deficiency. A total of 330 (65.0%) PW had UIC<150 µg/L. In terms of urinary iodine levels by region, the median UIC in Northern, Central and Southern regions were 136.3 µg/L, 85.5 µg/L and 97.4 µg/L respectively. The differences in median UIC between regions were significant. In addition, the Northern region (p = 0.001), Malay/Melanau ethnicity (p = 0.015) and parous parity (p = 0.014) were significantly associated with higher median UIC. No significant association was found for locality, age nor gravida.
    Conclusions This study indicates inadequate iodine status among PW in Sarawak despite seven years of mandatory USI. In fact, the majority of PW appear not to be protected against IDD and its consequences. In future, a comprehensive study should be carried out to determine the levels of iodine in salt at the retail outlets, villages and households in Sarawak.
    Keywords Iodine deficiency disorders - Pregnant women - Mandatory USI - Sarawak
  18. Saelim L, Akiyoshi N, Tan TT, Ihara A, Yamaguchi M, Hirano K, et al.
    J Plant Res, 2019 Jan;132(1):117-129.
    PMID: 30478480 DOI: 10.1007/s10265-018-1074-1
    The cell wall determines morphology and the environmental responses of plant cells. The primary cell wall (PCW) is produced during cell division and expansion, determining the cell shape and volume. After cell expansion, specific types of plant cells produce a lignified wall, known as a secondary cell wall (SCW). We functionally analyzed Group IIId Arabidopsis AP2/EREBP genes, namely ERF34, ERF35, ERF38, and ERF39, which are homologs of a rice ERF gene previously proposed to be related to SCW biosynthesis. Expression analysis revealed that these four genes are expressed in regions related to cell division and/or cell differentiation in seedlings (i.e., shoot apical meristems, the primordia of leaves and lateral roots, trichomes, and central cylinder of primary roots) and flowers (i.e., vascular tissues of floral organs and replums and/or valve margins of pistils). Overexpression of ERF genes significantly upregulated PCW-type, but not SCW-type, CESA genes encoding cellulose synthase catalytic subunits in Arabidopsis seedlings. Transient co-expression reporter analysis indicated that ERF35, ERF38, and ERF39 possess transcriptional activator activity, and that ERF34, ERF35, ERF38, and ERF39 upregulated the promoter activity of CESA1, a PCW-type CESA gene, through the DRECRTCOREAT elements, the core cis-acting elements known to be recognized by AP2/ERF proteins. Together, our findings show that Group IIId ERF genes are positive transcriptional regulators of PCW-type CESA genes in Arabidopsis and are possibly involved in modulating cellulose biosynthesis in response to developmental requirements and environmental stimuli.
  19. Rajah R, Hanif AA, Tan SSA, Lim PP, Karim SA, Othman E, et al.
    Int J Clin Pharm, 2019 Feb;41(1):237-243.
    PMID: 30506127 DOI: 10.1007/s11096-018-0762-1
    Background Detecting errors before medication dispensed or 'near misses' is a crucial step to combat the incidence of dispensing error. Despite this, no published evidence available in Malaysia relating to these issues. Objective To determine the incidence of medication labeling and filling errors, frequency of each type of the errors and frequency of the contributing factors at the final stage before dispensing. Setting Six Penang public funded hospitals outpatient pharmacies. Methods A prospective multicentre study, over 8 week's period. Pharmacists identified and recorded the details of either medication labeling and/or filling error at the final stage of counter-checking before dispensing. Besides, the contributing factors for each error were determined and recorded in data collection form. Descriptive analysis was used to explain the study data. Main outcome measure The incidence of near misses. Results A total of 187 errors (near misses) detected, with 59.4% (n = 111) were medication filling errors and 40.6% (n = 76) were labeling errors. Wrong drug (n = 44, 39.6%) was identified as the highest type of filling errors while incorrect dose (n = 34, 44.7%) was identified as the highest type of labeling errors. Distracted and interrupted work environment was reported to lead the highest labeling and filling errors, followed by lack of knowledge and skills for filling errors and high workload for labeling errors. Conclusion The occurrence of near misses related to medication filling and labelling errors is substantial at outpatient pharmacy in Penang public funded hospitals. Further research is warranted to evaluate the intervention strategies needed to reduce the near misses.
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