MyMedR

Displaying publications 21 - 40 of 58 in total

Abstract:

Sort:

Correction to: Cupriavidus malaysiensis sp. nov., a novel poly(3-hydroxybutyrate-co-4-hydroxybutyrate) accumulating bacterium isolated from the Malaysian environment

Ramachandran H, Shafie NAH, Sudesh K, Azizan MN, Majid MIA, Amirul AA

Antonie Van Leeuwenhoek, 2018 04;111(4):637.
PMID: 29285661 DOI: 10.1007/s10482-017-0998-0

In the original publication of the article, it was noted that Fig. 1 present an image of Cupriavidus malaysiensis strain USMAHM13 and not of strain USMAA1020, as indicated in the figure legend. The image in the original version is thus noted to serve as a record of strain USMAHM13 and the corrected version of Fig. 1 is reprinted below.
Gaining Insights on Nasopharyngeal Carcinoma Treatment Outcome Using Clinical Data Mining Techniques

Ghaibeh AA, Kasem A, Ng XJ, Nair HLK, Hirose J, Thiruchelvam V

Stud Health Technol Inform, 2018;247:386-390.
PMID: 29677988

The analysis of Electronic Health Records (EHRs) is attracting a lot of research attention in the medical informatics domain. Hospitals and medical institutes started to use data mining techniques to gain new insights from the massive amounts of data that can be made available through EHRs. Researchers in the medical field have often used descriptive statistics and classical statistical methods to prove assumed medical hypotheses. However, discovering new insights from large amounts of data solely based on experts' observations is difficult. Using data mining techniques and visualizations, practitioners can find hidden knowledge, identify interesting patterns, or formulate new hypotheses to be further investigated. This paper describes a work in progress on using data mining methods to analyze clinical data of Nasopharyngeal Carcinoma (NPC) cancer patients. NPC is the fifth most common cancer among Malaysians, and the data analyzed in this study was collected from three states in Malaysia (Kuala Lumpur, Sabah and Sarawak), and is considered to be the largest up-to-date dataset of its kind. This research is addressing the issue of cancer recurrence after the completion of radiotherapy and chemotherapy treatment. We describe the procedure, problems, and insights gained during the process.
Fulltext Multidrug-resistant Streptococcus pneumoniae causing invasive pneumococcal disease isolated from a paediatric patient

Arushothy R, Ramasamy H, Hashim R, Raj A S S, Amran F, Samsuddin N, et al.

Int J Infect Dis, 2020 Jan;90:219-222.
PMID: 31682962 DOI: 10.1016/j.ijid.2019.10.037

The emergence of non-vaccine multidrug-resistant Streptococcus pneumoniae serotypes is on rise. This study was performed to investigate a highly resistant serotype 15A S. pneumoniae isolated from the blood specimen of a 20-month-old patient who died of her infection. The SS40_16 isolate was resistant to erythromycin, co-trimoxazole, tetracycline, and chloramphenicol, as well as to penicillin, ceftriaxone, and cefotaxime (using meningitis cut-off points, Clinical and Laboratory Standards Institute). The isolate belonged to sequence type 1591 (ST1591) and was related to CC81 clonal complex, suggesting the possibility of horizontal gene transfer. Scanning electron microscopy comparison between resistant and sensitive pneumococcal isolates also indicated similar phenotypic characteristics that confer high resistance. The emergence of highly resistant non-vaccine pneumococci is of great concern to public health and in the clinical setting. Pneumococcal surveillance programs represent a crucial tool, not only for determining the impact of pneumococcal conjugate vaccines, but also for monitoring the selective pressure of serotype replacement with regard to the treatment of invasive pneumococcal disease.
Above or below 14 years? An orthopantomographic study based on chronological course of eruption of mandibular premolars and second molars in a sample of south Indian children

Thomas LA, Thomas LR, Balla SB, Gopalaiah H, Kanaparthi A, Sai Sravanthi G, et al.

Leg Med (Tokyo), 2021 Feb;48:101814.
PMID: 33246253 DOI: 10.1016/j.legalmed.2020.101814

In the context of dental age assessment, two significant factors can be studied; tooth mineralisation and tooth emergence. Little is known about the role of a second molar eruption in forensic age estimation. This paper aims to contribute to forensic age estimation using an age threshold of 14 years, studying the eruption stages of permanent mandibular premolars and second molars. Totally 640 orthopantomograms (OPGs) of south Indian children, aged between 10 and 18 years, were evaluated using Olze et al. staging of tooth eruption stages (A-D). Spearman's rho correlation showed a strong, positive, and statistically significant correlation between the chronological age and the eruption stages of both sexes' teeth. Accuracy, sensitivity, specificity, likelihood ratios, and post-test probability values were calculated for all tested teeth. The best performance to discriminate individuals above or below 14 years showed stage D in second molars. The sensitivity varied between 89% and 94% and specificity between 75% and 84%, respectively. Receiver operating characteristic curve analysis revealed high diagnostic performance for stage D, with area under the ROC curve (AUC) values of 84% and 85% for tooth 37 and 85% and 83% for tooth 47 in males and females, respectively. In conclusion, it is possible to predict age over 14 years in south Indian children using tooth emergence stages from OPGs with a relatively high interobserver agreement and good diagnostic accuracy. However, there are some limitations and, therefore, must be used in conjunction with other methods.
Fulltext A Rare Occurrence of Premature Birth and Recurrent Acute Pulmonary Oedema in the Mother due to Cushing's Syndrome: A Case Report

Bernard DMAA, Yi OX, Veerasamy HLA, Bidin MBL, Keong SC

J ASEAN Fed Endocr Soc, 2021;36(2):200-204.
PMID: 34966205 DOI: 10.15605/jafes.036.02.04

Presentation of Cushing's syndrome during pregnancy is extremely rare. We report a 21-year-old female with Cushing's syndrome diagnosed at 23 weeks of gestation and had recurrent acute pulmonary oedema during the antepartum and postpartum period. She delivered prematurely via emergency caesarean section at 28 weeks of gestation. This case highlights the rare occurrence of recurrent acute pulmonary oedema during pregnancy and consequential premature birth in a patient with adrenal Cushing's. She was diagnosed with adrenal Cushing's during the postpartum period based on unsuppressed serum cortisol after overnight and low-dose dexamethasone suppression test with a suppressed ACTH. CT scan of the adrenal glands revealed a right adrenal cortical adenoma. The risk of complications in infants and mothers who suffer from Cushing's syndrome needs to be handled carefully. The diagnosis of Cushing's syndrome in pregnant women often overlaps and is difficult to establish in early pregnancy.
Fulltext Investigating associations between emotional and behavioral problems, self-esteem, and parental attachment among adolescents: A cross-sectional study in Indonesia

Sarfika R, Moh Yanuar Saifudin IM, Sari IM, Murni D, Malini H, Abdullah KL

Heliyon, 2023 Nov;9(11):e21459.
PMID: 38027961 DOI: 10.1016/j.heliyon.2023.e21459

BACKGROUND: Emotional and Behavioral Problems (EBPs) are prevalent among adolescents, and adolescents' capacity for adaptation can be influenced by their interactions with their parents, environment, and self-esteem. This link has not been systematically examined among adolescents in West Sumatra, Indonesia. This study aimed to assess the association of parental attachment and self-esteem with EBPs in adolescents.
METHODS: A cross-sectional study was conducted from July to November 2022 in Padang West Sumatra, Indonesia. In total, 854 students from public senior high school 4 Padang were involved in this study and completed questionnaires on demographics, EBPs, parental attachment, and self-esteem. There was a total of five subscales for EBPs, which included emotional problems, conduct problems, hyperactivity, peer problems and prosocial. Additionally, there were three subscales for parental attachment, which included the mother's attachment, father's attachment, and peer attachment. Spearman's correlation, independent-sample t-tests, ANOVA and multiple linear regression analysis were employed to examine factors associated with EBPs.
RESULTS: This study showed that father's attachment (r = -0.191, p
Fulltext Skin cancer detection using non-invasive techniques

Narayanamurthy V, Padmapriya P, Noorasafrin A, Pooja B, Hema K, Firus Khan AY, et al.

RSC Adv, 2018 Aug 02;8(49):28095-28130.
PMID: 35542700 DOI: 10.1039/c8ra04164d

Skin cancer is the most common form of cancer and is globally rising. Historically, the diagnosis of skin cancers has depended on various conventional techniques which are of an invasive manner. A variety of commercial diagnostic tools and auxiliary techniques are available to detect skin cancer. This article explains in detail the principles and approaches involved for non-invasive skin cancer diagnostic methods such as photography, dermoscopy, sonography, confocal microscopy, Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis. The characteristics of an ideal screening test are outlined, and the authors pose several points for clinicians and scientists to consider in the evaluation of current and future studies of skin cancer detection and diagnosis. This comprehensive review critically analyses the literature associated with the field and summarises the recent updates along with their merits and demerits.
Pulmonary extra-nodal mucosa-associated lymphoid tissue (MALT) lymphoma: A rare cause of persistent lung consolidation

Kou L, Huan NC, Nyanti LE, Chin JS, Mohamad NB, Ramarmuty HY

Respirol Case Rep, 2023 Aug;11(8):e01197.
PMID: 37501686 DOI: 10.1002/rcr2.1197

Pulmonary extra-nodal marginal zone B-cell lymphoma, also known as extra-nodal mucosa-associated lymphoid tissue (MALT) lymphoma, is rare among all non-Hodgkin lymphomas and generally among all pulmonary malignancies. We present a 46-year-old lady with persistent right lower lung consolidation despite earlier treatment efforts with intravenous antibiotics for community acquired pneumonia. Apart from initial presentation with a short 3-day history of fever, cough and shortness of breath, she had remained largely asymptomatic throughout the follow-up period. Flexible bronchoscopy done ruled out infectious aetiologies but transbronchial lung biopsies showed atypical lymphocytes. A computed tomography guided core biopsy of her right lung consolidation was subsequently performed, confirming a diagnosis of pulmonary MALT lymphoma. She was promptly referred to the haematology team for further management and commencement of chemotherapy. Pulmonary MALT lymphoma, albeit uncommon and often follows a relatively indolent cause, should be considered as a differential diagnosis among patients with persistent lung consolidation.
FT-IR, NBO, HOMO-LUMO, MEP analysis and molecular docking study of Methyl N-({[2-(2-methoxyacetamido)-4-(phenylsulfanyl)phenyl]amino}[(methoxycarbonyl) imino]methyl)carbamate

Panicker CY, Varghese HT, Narayana B, Divya K, Sarojini BK, War JA, et al.

Spectrochim Acta A Mol Biomol Spectrosc, 2015 Sep 5;148:29-42.
PMID: 25863457 DOI: 10.1016/j.saa.2015.03.064

The optimized molecular structure, vibrational frequencies, corresponding vibrational assignments of Methyl N-({[2-(2-methoxyacetamido)-4-(phenylsulfanyl) phenyl]amino} [(methoxycarbonyl)imino]methyl)carbamate have been investigated using HF and DFT levels of calculations. The geometrical parameters are in agreement with XRD data. The stability of the molecule arising from hyper-conjugative interaction and charge delocalization has been analyzed using NBO analysis. The HOMO and LUMO analysis is used to determine the charge transfer within the molecule. Molecular electrostatic potential study was also performed. The first and second hyperpolarizability was calculated in order to find its role in nonlinear optics. Molecular docking studies are also reported. Prediction of Activity Spectra analysis of the title compound predicts anthelmintic and antiparasitic activity as the most probable activity with Pa (probability to be active) value of 0.808 and 0.797, respectively. Molecular docking studies show that both the phenyl groups and the carbonyl oxygens of the molecule are crucial for bonding and these results draw us to the conclusion that the compound might exhibit pteridine reductase inhibitory activity.
The Cambridge Anti-myopia Study: variables associated with myopia progression

Price H, Allen PM, Radhakrishnan H, Calver R, Rae S, Theagarayan B, et al.

Optom Vis Sci, 2013 Nov;90(11):1274-83.
PMID: 24100478 DOI: 10.1097/OPX.0000000000000067

To identify variables associated with myopia progression and to identify any interaction between accommodative function, myopia progression, age, and treatment effect in the Cambridge Anti-Myopia Study.
Fulltext A scoping review of digital workplace wellness interventions in low- and middle-income countries

Thai YC, Sim D, McCaffrey TA, Ramadas A, Malini H, Watterson JL

PLoS One, 2023;18(2):e0282118.
PMID: 36854022 DOI: 10.1371/journal.pone.0282118

INTRODUCTION: Digital technology-based interventions have gained popularity over the last two decades, due to the ease with which they are scalable and low in implementation cost. Multicomponent health promotion programmes, with significant digital components, are increasingly being deployed in the workplace to assess and promote employees' health behaviours and reduce risk of chronic diseases. However, little is known about workplace digital health interventions in low- and middle- income countries (LMICs).
METHODS: Various combinations of keywords related to "digital health", "intervention", "workplace" and "developing country" were applied in Ovid MEDLINE, EMBASE, CINAHL Plus, PsycINFO, Scopus and Cochrane Library for peer-reviewed articles in English language. Manual searches were performed to supplement the database search. The screening process was conducted in two phases and a narrative synthesis to summarise the data. The review protocol was written prior to undertaking the review (OSF Registry:10.17605/OSF.IO/QPR9J).
RESULTS: The search strategy identified 10,298 publications, of which 24 were included. Included studies employed the following study designs: randomized-controlled trials (RCTs) (n = 12), quasi-experimental (n = 4), pilot studies (n = 4), pre-post studies (n = 2) and cohort studies (n = 2). Most of the studies reported positive feedback of the use of digital wellness interventions in workplace settings.
CONCLUSIONS: This review is the first to map and describe the impact of digital wellness interventions in the workplace in LMICs. Only a small number of studies met the inclusion criteria. Modest evidence was found that digital workplace wellness interventions were feasible, cost-effective, and acceptable. However, long-term, and consistent effects were not found, and further studies are needed to provide more evidence. This scoping review identified multiple digital health interventions in LMIC workplace settings and highlighted a few important research gaps.
Fulltext Pleural fluid milkshakes: three cases with different aetiologies

Huan NC, Tan HA, Ramarmuty HY, Ponnuvelu S, Letcheminan S, Sivaraman Kannan KK

Respirol Case Rep, 2023 Apr;11(4):e01116.
PMID: 36910134 DOI: 10.1002/rcr2.1116

In clinical practice, chylothorax is usually suspected in any patient with milky pleural fluid. However, contrary to popular belief, milky appearance of pleural fluid is seen in less than half of patients with chylothorax. A high index of suspicion for chylothorax is therefore needed in any turbid, bloody, or serosanguinous effusions of unclear aetiology. In this case series, we present three patients with biochemically proven chylothorax: each with a different presentation, pleural fluid appearance, underlying cause, management strategy and clinical outcome. The first patient developed 'milky' chylothorax secondary to lymphoma while the second patient's 'yellow' chylothorax is related to pleural tuberculosis. The final patient suffered from 'pink' chylothorax in the setting of systemic amyloidosis. In each of the cases, prompt diagnosis of chylothorax followed by efforts to elucidate the underlying cause are crucial steps to guide subsequent management with the main aim to ensure a better clinical outcome.
Fulltext The utility of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) for the diagnosis of mediastinal lymphoma

Huan NC, Lee WL, Ramarmuty HY, Nyanti LE, Tsen MSL, Yunus D

Respirol Case Rep, 2024 Apr;12(4):e01342.
PMID: 38576853 DOI: 10.1002/rcr2.1342

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a revolutionary tool for the diagnosis and staging of mediastinal disorders. Nevertheless, its diagnostic capability is reduced in certain disorders such as lymphoproliferative diseases. EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) is a novel technique that can provide larger samples with preserved tissue architecture, with an acceptable safety profile. In this case report, we present a middle-aged gentleman with a huge anterior mediastinal mass and bilateral mediastinal and hilar lymphadenopathy. He underwent EBUS-TBNA with rapid on-site evaluation (ROSE) followed by EBUS-TBMC, all under general anaesthesia. Histopathological analysis showed discordance between EBUS-TBNA and EBUS-TBMC in which only TBMC samples provided adequate tissue to attain a diagnosis of primary mediastinal large B-cell lymphoma. This case report reinforced the diagnostic role of EBUS-TBMC in the diagnosis of lymphoproliferative diseases.
Fulltext Chimeric antigen receptor-natural killer cell therapy: current advancements and strategies to overcome challenges

Kong JC, Sa'ad MA, Vijayan HM, Ravichandran M, Balakrishnan V, Tham SK, et al.

Front Immunol, 2024;15:1384039.
PMID: 38726000 DOI: 10.3389/fimmu.2024.1384039

Chimeric antigen receptor-natural killer (CAR-NK) cell therapy is a novel immunotherapy targeting cancer cells via the generation of chimeric antigen receptors on NK cells which recognize specific cancer antigens. CAR-NK cell therapy is gaining attention nowadays owing to the ability of CAR-NK cells to release potent cytotoxicity against cancer cells without side effects such as cytokine release syndrome (CRS), neurotoxicity and graft-versus-host disease (GvHD). CAR-NK cells do not require antigen priming, thus enabling them to be used as "off-the-shelf" therapy. Nonetheless, CAR-NK cell therapy still possesses several challenges in eliminating cancer cells which reside in hypoxic and immunosuppressive tumor microenvironment. Therefore, this review is envisioned to explore the current advancements and limitations of CAR-NK cell therapy as well as discuss strategies to overcome the challenges faced by CAR-NK cell therapy. This review also aims to dissect the current status of clinical trials on CAR-NK cells and future recommendations for improving the effectiveness and safety of CAR-NK cell therapy.
Gut Microbiota Profiles in Myopes and Nonmyopes

Omar WEW, Singh G, McBain AJ, Cruickshank F, Radhakrishnan H

Invest Ophthalmol Vis Sci, 2024 May 01;65(5):2.
PMID: 38691091 DOI: 10.1167/iovs.65.5.2

PURPOSE: To identify compositional differences in the gut microbiome of nonmyopes (NM) and myopes using 16S ribosomal RNA sequencing and to investigate whether the microbiome may contribute to the onset or progression of the condition.
METHODS: Faecal samples were collected from 52 adult participants, of whom 23 were NM, 8 were progressive myopes (PM), and 21 were stable myopes (SM). The composition of the gut microbiota in each group was analysed using 16S ribosomal RNA gene sequencing.
RESULTS: There were no significant differences in alpha and beta diversity between the three groups (NM, PM, and SM). However, the distributions of Bifidobacterium, Bacteroides, Megamonas, Faecalibacterium, Coprococcus, Dorea, Roseburia, and Blautia were significantly higher in the myopes (SM and PM combined) when compared with emmetropes. The myopes exhibited significantly greater abundance of bacteria that are linked to the regulation of dopaminergic signalling, such as Clostridium, Ruminococcus, Bifidobacterium, and Bacteroides. Individuals with stable myopia were found to have a significantly higher proportion of Prevotella copri than those with progressive myopia. Bifidobacterium adolescentis, a gamma-aminobutyric acid (GABA)-producing bacterium, was significantly higher in all myopes than in NM and, in the comparison between SM and PM, it is significantly higher in SM. B. uniformis and B. fragilis, both GABA-producing Bacteroides, were present in relatively high abundance in all myopes and in SM compared with PM, respectively.
CONCLUSIONS: The presence of bacteria related to dopamine effect and GABA-producing bacteria in the gut microbiome of myopes may suggest a role of these microorganisms in the onset and progression of myopia.
Multiple intrathoracic extramedullary haematopoiesis as visualised on medical thoracoscopy

Lee JH, Nyanti LE, Huan NC, Ramarmuty HY, Sivaraman Kannan KK

Thorax, 2024 Jul 05.
PMID: 38969502 DOI: 10.1136/thorax-2024-221593
Fulltext Feasibility, safety and outcomes of stereotactic radiotherapy for ultra-central thoracic oligometastatic disease guided by linear endobronchial ultrasound-inserted fiducials

Sidhu C, Tang C, Scott A, Yamini Ramamurty H, Yagnik L, Morey S, et al.

Radiother Oncol, 2024 Dec;201:110547.
PMID: 39332638 DOI: 10.1016/j.radonc.2024.110547

BACKGROUND & PURPOSE: Local treatment of oligometastases has been found to improve survival and prognosis. Stereotactic body radiotherapy (SBRT) has emerged as a treatment option for oligometastases but its use in ultra-central (UC) areas can cause significant toxicity and mortality. Fiducial markers (FM) can be used to improve SBRT accuracy, and can be inserted in the central thorax using linear endobronchial ultrasound (EBUS) bronchoscopy. Outcomes of FM-guided SBRT for UC thoracic oligometastases is unknown.
METHODS: A single-centre retrospective study investigating the feasibility, safety and outcomes of both linear EBUS-inserted FMs and subsequent FM-guided SBRT for UC-oligometastatic disease. Motion analyses of FMs were also performed.
RESULTS: Thirty outpatients underwent 32 EBUS-FM insertion procedures with 100 % success, and no major procedural mortality or morbidity. Minor complications were 4.8 % incidence of delayed FM-displacement. UC FM-guided SBRT was completed in 20 patients with 99.9 % fractions delivered. Median SBRT dose delivered was 40 Gy over a median of 8 fractions. Majority of adverse events were Grade 1 and there was no SBRT-related mortality. Local control with SBRT was 95 %, with overall survival at 1-year and 3-years of 90 % and 56.3 % respectively. Median overall survival after SBRT was 43.6 months. FM movements in UC areas were recorded being greatest in the superior-inferior axis.
CONCLUSION: Combined linear EBUS sampling and FM-insertion in UC thoracic oligometastatic disease is feasible and safe. UC-SBRT to oligometastases using FM guidance was found to have minimal complications and associated with moderate survival up to 3 years post-treatment.
Potential of salivary biomarkers for diagnosing and prognosing rheumatoid arthritis: A systematic review and meta-analysis: Salivary biomarkers in Rheumatoid Arthritis patients - A systematic review with Meta-analysis

Pandarathodiyil AK, Kasirajan HS, Vemuri S, Sujai GVNS, B S, Ramadoss R

J Stomatol Oral Maxillofac Surg, 2025 Mar;126(2):102074.
PMID: 39277136 DOI: 10.1016/j.jormas.2024.102074

BACKGROUND: Rheumatoid arthritis (RA) is a chronic debilitating autoimmune disorder. Blood biomarkers, like rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs), lack the sensitivity and specificity for early diagnosis, delaying treatment. This review while highlighting the need for new diagnostic tools, emphasizes the promising avenue of saliva for developing RA biomarkers.
OBJECTIVE: This systematic review and meta-analysis assess the effectiveness of salivary biomarkers in the diagnosis and prognosis of RA, examining current evidence and proposing avenues for future research.
METHODOLOGY: A literature review following PRISMA 2021 guidelines was conducted using PubMed, Scopus, Web of Science, and Google Scholar to identify studies from the past five years on salivary biomarkers in RA patients compared to healthy controls.
RESULT: The review focused on original research articles, and meta-analysis was performed on studies reporting standard deviation values for inflammatory markers such as IL-6, IL-8, MMP-8, and TNF-alpha. The meta-analysis included eleven studies with 394 RA patients and 255 healthy controls, evaluating IL-8, IL-6, MMP-8, and TNF-α as RA biomarkers. IL-8 showed a mean difference of 7.32 (CI: -5.48 to 20.13), not statistically significant, favouring controls. IL-6 had a CI of -0.09 (CI: -2.20 to 2.02) with high heterogeneity (I² = 98%), suggesting its potential as a diagnostic and prognostic biomarker. TNF-α and MMP-8 showed no significant differences (CIs: 4.54 and 2.71, respectively).
CONCLUSION: This systematic review and meta-analysis emphasize saliva's potential in identifying RA biomarkers, especially IL-6, which is associated with the disease's pathogenesis. However, significant evidence heterogeneity necessitates larger, multicentric studies for validation.
Digital monitoring of medication safety in children: an investigation of ADR signalling techniques in Malaysia

Rekha BH, Hisham SA, Wahab IA, Ali NM, Goh KW, Ming LC

BMC Med Inform Decis Mak, 2024 Dec 18;24(1):395.
PMID: 39695558 DOI: 10.1186/s12911-024-02801-y

BACKGROUND: Digital solutions can help monitor medication safety in children who are often excluded in clinical trials. The lack of reliable safety data often leads to either under- or over-dose of medications during clinical management which make them either not responding well to treatment or susceptible to adverse drug reactions (ADRs).
AIM: This study investigated ADR signalling techniques to detect serious ADRs in Malaysian children aged from birth to 12 years old using an electronic ADRs' database.
METHODS: Four techniques (Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN) and Multi-item Gamma Poisson Shrinker (MGPS)) were tested on ADR reports submitted to the National Pharmaceutical Regulatory Agency between 2016 and 2020. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the techniques were compared.
RESULTS: A total of 31 medicine-Important Medical Event pairs were found and examined among the 3152 paediatric ADR reports. Three techniques (PRR, ROR, MGPS) signalled oculogyric crisis and dystonia for metoclopramide. BCPNN and MGPS signalled angioedema for paracetamol, amoxicillin and ibuprofen. Similar performances were found for PRR, ROR and BCPNN (sensitivity of 12%, specificity of 100%, PPV of 100% and NPV of 21%). MGPS revealed the highest sensitivity (20%) and NPV (23%), as well as similar specificity and PPV (100%).
CONCLUSIONS: This study suggests that medication safety signalling techniques could be applied on electronic health records to monitor medication safety issues in children. Clinicians and medication safety specialist could prioritise the signals for further clinical consideration and prompt response.
Changes in blood-brain barrier permeability and ultrastructure, and protein expression in a rat model of cerebral hypoperfusion

Sekaran H, Gan CY, A Latiff A, Harvey TM, Mohd Nazri L, Hanapi NA, et al.

Brain Res Bull, 2019 10;152:63-73.
PMID: 31301381 DOI: 10.1016/j.brainresbull.2019.07.010

Cerebral hypoperfusion involved a reduction in cerebral blood flow, leading to neuronal dysfunction, microglial activation and white matter degeneration. The effects on the blood-brain barrier (BBB) however, have not been well-documented. Here, two-vessel occlusion model was adopted to mimic the condition of cerebral hypoperfusion in Sprague-Dawley rats. The BBB permeability to high and low molecular weight exogenous tracers i.e. Evans blue dye and sodium fluorescein respectively, showed marked extravasation of the Evans blue dye in the frontal cortex, posterior cortex and thalamus-midbrain at day 1 following induction of cerebral hypoperfusion. Transmission electron microscopy revealed brain endothelial cell and astrocyte damages including increased pinocytotic vesicles and formation of membrane invaginations in the endothelial cells, and swelling of the astrocytes' end-feet. Investigation on brain microvessel protein expressions using two-dimensional (2D) gel electrophoresis coupled with LC-MS/MS showed that proteins involved in mitochondrial energy metabolism, transcription regulation, cytoskeleton maintenance and signaling pathways were differently expressed. The expression of aconitate hydratase, heterogeneous nuclear ribonucleoprotein, enoyl Co-A hydratase and beta-synuclein were downregulated, while the opposite observed for calreticulin and enhancer of rudimentary homolog. These findings provide insights into the BBB molecular responses to cerebral hypoperfusion, which may assist development of future therapeutic strategies.

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links