Displaying publications 421 - 440 of 5421 in total

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  1. Mohd Fauzi NA, Abdullah S, Tan AH, Mohd Ramli N, Tan CY, Lim SY
    Parkinsonism Relat Disord, 2020 06;75:110-113.
    PMID: 30846242 DOI: 10.1016/j.parkreldis.2019.02.025
    We report a case of relapsing-remitting opsoclonus-myoclonus-ataxia syndrome (OMAS) in a patient with Hashimoto's encephalopathy, diagnosed after comprehensive evaluation. OMAS as a manifestation of Hashimoto's encephalopathy has been reported once previously. It is hoped that recognition of this entity and early initiation of immunotherapy will improve clinical outcomes for patients.
    Matched MeSH terms: Hashimoto Disease/complications*; Hashimoto Disease/diagnosis; Hashimoto Disease/drug therapy
  2. Heng WS, Pore M, Meijer C, Hiltermann TJN, Cheah SC, Gosens R, et al.
    Lung Cancer, 2021 04;154:13-22.
    PMID: 33607458 DOI: 10.1016/j.lungcan.2021.02.002
    OBJECTIVES: Cancer stem cells (CSCs) have been implicated in disease progression of aggressive cancers including small cell lung carcinoma (SCLC). Here, we have examined the possible contribution of CSCs to SCLC progression and aggressiveness.

    MATERIALS AND METHODS: GLC-14, GLC-16 and GLC-19 SCLC cell lines derived from one patient, representing increasing progressive stages of disease were used. CSC marker expressions was determined by RT-qPCR and western blotting analyses, and heterogeneity was studied by CSC marker expression by immunofluorescence microscopy and flow cytometry. Colony formation assays were used to assess stem cell properties and therapy sensitivity.

    RESULTS: Increasing expression of stem cell markers MYC, SOX2 and particularly CD44 were found in association with advancing disease. Single and overlapping expression of these markers indicated the presence of different CSC populations. The accumulation of more homogeneous double- and triple-positive CSC populations evolved with disease progression. Functional characterization of CSC properties affirmed higher proficiency of colony forming ability and increased resistance to γ-irradiation in GLC-16 and GLC-19 compared to GLC-14. GLC-19 colony formation was significantly inhibited by a human anti-CD44 antibody.

    CONCLUSION: The progressive increase of MYC, SOX2 and particularly CD44 expression that was accompanied with enhanced colony forming capacity and resistance in the in vitro GLC disease progression model, supports the potential clinical relevance of CSC populations in malignancy and disease relapse of SCLC.

    Matched MeSH terms: Disease Progression
  3. Yap KH, Warren N, Allotey P, Reidpath DD
    Aging Ment Health, 2020 05;24(5):709-716.
    PMID: 30588848 DOI: 10.1080/13607863.2018.1550632
    Background: Subjective memory complaints (SMC) are common in the elderly and have been suggested as the first subtle sign of decline which can predict dementia. Cognitive decline is thought to be related to inflammatory processes similarly found in other chronic diseases and conditions such as stroke, heart disease and arthritis. This study aimed to examine the association of SMC with chronic diseases and the profile of these health conditions reported by a group of older adults.Methods: Data from a cross-sectional survey conducted from August 2013 and March 2014 was drawn from 6179 individuals aged 56 years and above. Multivariable logistic regression analyses were used to examine SMC's relationship with individual chronic diseases (asthma, kidney disease, heart disease, stroke, arthritis, hypertension and diabetes) and multimorbidity. Latent class analysis (LCA) was used to identify the profile of health conditions. The effect of SMC was estimated in a multinomial logistic regression as part of the latent class model.Results: SMC was statistically significant in its association with asthma, stroke, heart disease, arthritis and multimorbidity in the fully controlled multivariable logistic regression models. Three health profiles were identified: low comorbidity (n = 4136, low rates in all health conditions), arthritis group (n = 860) and diabetes and hypertension group (n = 1183). SMC was associated with arthritis group (OR = 2.04, 95% CI = 1.51-2.75) and diabetes and hypertension group (OR = 1.22, 95% CI = 1.03-1.46).Conclusion: Adapting a combination of analytical approaches allows a better understanding in the assessment of SMC's relationship with chronic diseases and the patterns of distribution of these health conditions.
    Matched MeSH terms: Chronic Disease
  4. Faisal, A.H., Andrea, Y.L.B., Nina, M., Tidi, H., Ahmad Izuanuddin, I.
    Medicine & Health, 2020;15(2):140-152.
    MyJurnal
    Insiden penyakit paru-paru obstruktif kronik (COPD) di Malaysia semakin meningkat. Tiada kajian yang dilaporkan tentang obstruksi aliran udara spirometrik, termasuk corak restriktif dan obstruksif pada populasi di Malaysia. Kajian ini dilakukan untuk mengira prevalens dan meramal obstruksi aliran udara dan menjalankan pemeriksaan gejala COPD menggunakan peralatan baru AirSmart® Spirometry dan COPD Population Screener (COPD-PS). Kajian keratan rentas dilakukan di dua hospital tertiari menggunakan COPD-PS dan AirSmart® Spirometry. Terdapat 265 subjek yang direkrut dengan 11% dan 16% populasi yang masing-masing disaring mempunyai corak yang restriktif dan obstruksif. Dua puluh peratus subjek mempunyai skor COPD-PS lebih daripada lima. Tujuh puluh empat peratus subjek dengan corak obstruktif aktif atau bekas perokok (p=0,03, p
    Matched MeSH terms: Pulmonary Disease, Chronic Obstructive
  5. Andrea, B.Y.L., Faisal, A.H., Chong, G.Y., Syed Zulkifli, S.Z.
    Medicine & Health, 2020;15(2):85-95.
    MyJurnal
    Tuberkulosis (TB) paru-paru dan penyakit “Chronic Obstructive Pulmonary Disease” (COPD) adalah punca utama kematian dan morbiditi di Malaysia. Di Malaysia, jumlah kes TB semakin meningkat dan terdapat 500,000 rakyat Malaysia yang didiagnosa dengan COPD pada tahun 2016. Sejumlah besar pesakit TB mendapat “COPD” pada jangka panjang. Jangkitan TB yang lepas telah terbukti menyumbang kepada etiologi COPD. Kami menjalankan kajian keratan rentas selama satu tahun yang melibatkan pesakit dewasa di klinik pesakit luar di Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC) yang mempunyai sejarah TB paru-paru 3 tahun sebelum kajian. Pesakit yang dikecualikan adalah pesakit asma, COPD, penyakit paru-paru interstitial dan bronchiectasis. Obstruksi aliran udara ditakrifkan sebagai nisbah FEV1: FVC
    Matched MeSH terms: Pulmonary Disease, Chronic Obstructive
  6. Mazumdar P, Singh P, Kethiravan D, Ramathani I, Ramakrishnan N
    Planta, 2021 May 08;253(6):119.
    PMID: 33963935 DOI: 10.1007/s00425-021-03636-x
    MAIN CONCLUSION: This review provides insights into the molecular interactions between Phytophthora infestans and tomato and highlights research gaps that need further attention. Late blight in tomato is caused by the oomycota hemibiotroph Phytophthora infestans, and this disease represents a global threat to tomato farming. The pathogen is cumbersome to control because of its fast-evolving nature, ability to overcome host resistance and inefficient natural resistance obtained from the available tomato germplasm. To achieve successful control over this pathogen, the molecular pathogenicity of P. infestans and key points of vulnerability in the host plant immune system must be understood. This review primarily focuses on efforts to better understand the molecular interaction between host pathogens from both perspectives, as well as the resistance genes, metabolomic changes, quantitative trait loci with potential for improvement in disease resistance and host genome manipulation via transgenic approaches, and it further identifies research gaps and provides suggestions for future research priorities.
    Matched MeSH terms: Disease Resistance
  7. Yavari Nejad F, Varathan KD
    BMC Med Inform Decis Mak, 2021 04 30;21(1):141.
    PMID: 33931058 DOI: 10.1186/s12911-021-01493-y
    BACKGROUND: Dengue fever is a widespread viral disease and one of the world's major pandemic vector-borne infections, causing serious hazard to humanity. The World Health Organisation (WHO) reported that the incidence of dengue fever has increased dramatically across the world in recent decades. WHO currently estimates an annual incidence of 50-100 million dengue infections worldwide. To date, no tested vaccine or treatment is available to stop or prevent dengue fever. Thus, the importance of predicting dengue outbreaks is significant. The current issue that should be addressed in dengue outbreak prediction is accuracy. A limited number of studies have conducted an in-depth analysis of climate factors in dengue outbreak prediction.

    METHODS: The most important climatic factors that contribute to dengue outbreaks were identified in the current work. Correlation analyses were performed in order to determine these factors and these factors were used as input parameters for machine learning models. Top five machine learning classification models (Bayes network (BN) models, support vector machine (SVM), RBF tree, decision table and naive Bayes) were chosen based on past research. The models were then tested and evaluated on the basis of 4-year data (January 2010 to December 2013) collected in Malaysia.

    RESULTS: This research has two major contributions. A new risk factor, called the TempeRain factor (TRF), was identified and used as an input parameter for the model of dengue outbreak prediction. Moreover, TRF was applied to demonstrate its strong impact on dengue outbreaks. Experimental results showed that the Bayes Network model with the new meteorological risk factor identified in this study increased accuracy to 92.35% for predicting dengue outbreaks.

    CONCLUSIONS: This research explored the factors used in dengue outbreak prediction systems. The major contribution of this study is identifying new significant factors that contribute to dengue outbreak prediction. From the evaluation result, we obtained a significant improvement in the accuracy of a machine learning model for dengue outbreak prediction.

    Matched MeSH terms: Disease Outbreaks
  8. Inoue M, Isa ILM, Orita S, Suzuki-Narita M, Inage K, Shiga Y, et al.
    Spine (Phila Pa 1976), 2021 Aug 01;46(15):E810-E816.
    PMID: 34228691 DOI: 10.1097/BRS.0000000000003921
    STUDY DESIGN: An in vivo model to study the effect of an injectable hyaluronic acid (HA) hydrogel following puncture-induced lumbar disc injury in rabbits.

    OBJECTIVES: The aim of this study was to determine the efficacy of an injectable HA hydrogel to maintain disc height and tissue hydration, promote structural repair, and attenuate inflammation and innervation in the lumbar discs.

    SUMMARY OF BACKGROUND DATA: Previously, we have demonstrated that HA hydrogel alleviated inflammation, innervation, and pain to promote disc repair. Nevertheless, the effect of an injectable HA hydrogel in the lumbar disc in a weight-bearing animal model was not performed.

    METHODS: We have adopted a surgically puncture-induced disc injury at lumbar levels in a rabbit model. The discs were grouped into sham, puncture with water injection, and puncture with HA hydrogel injection. Postoperatively, we measured changes in disc height using x-ray. We used magnetic resonance imaging to assess disc degeneration on tissue hydration after euthanasia. Post-mortem, we determined histological changes, innervation (PGP9.5) and inflammation (interleukin [IL]-6, IL-1β, and tumor necrosis factor [TNF]-α) in the discs.

    RESULTS: We have demonstrated a significant reduction of disc height and T2/T1ρ mapping with histological evidence of degenerative discs, increase of innervation and inflammation in puncture-induced disc injury over time. In the HA hydrogel group, disc height was increased at weeks four and eight. A slight increase of T2 mapping, but significantly in T1ρ mapping, was observed in the HA hydrogel group at week 8. We observed homogenous NP distribution and organised AF lamellae at week eight and a slight reduced innervation score in the treatment group. HA hydrogel significantly downregulated IL-6 expression at day 1. This, however, was only slightly reduced for IL-1β and TNF-α.

    CONCLUSION: An injectable HA hydrogel had the protective effects in suppressing the loss of disc height, promoting tissue hydration for structural repair, and attenuating inflammation and innervation to prevent further disc degeneration.Level of Evidence: N/A.

    Matched MeSH terms: Disease Models, Animal
  9. Rohani A, Suzilah I, Malinda M, Anuar I, Mohd Mazlan I, Salmah Maszaitun M, et al.
    Trop Biomed, 2011 Aug;28(2):237-48.
    PMID: 22041742
    Early detection of a dengue outbreak is an important first step towards implementing effective dengue interventions resulting in reduced mortality and morbidity. A dengue mathematical model would be useful for the prediction of an outbreak and evaluation of control measures. However, such a model must be carefully parameterized and validated with epidemiological, ecological and entomological data. A field study was conducted to collect and analyse various parameters to model dengue transmission and outbreak. Dengue prone areas in Kuala Lumpur, Pahang, Kedah and Johor were chosen for this study. Ovitraps were placed outdoor and used to determine the effects of meteorological parameters on vector breeding. Vector population in each area was monitored weekly for 87 weeks. Weather stations, consisting of a temperature and relative humidity data logger and an automated rain gauge, were installed at key locations in each study site. Correlation and Autoregressive Distributed Lag (ADL) model were used to study the relationship among the variables. Previous week rainfall plays a significant role in increasing the mosquito population, followed by maximum humidity and temperature. The secondary data of rainfall, temperature and humidity provided by the meteorological department showed an insignificant relationship with the mosquito population compared to the primary data recorded by the researchers. A well fit model was obtained for each locality to be used as a predictive model to foretell possible outbreak.
    Matched MeSH terms: Disease Outbreaks*; Disease Vectors*
  10. Balqis-Ali NZ, Fun WH, Ismail M, Ng RJ, Jaaffar FSA, Low LL
    PMID: 34501637 DOI: 10.3390/ijerph18179047
    Strengthening the health systems through gaps identification is necessary to ensure sustainable improvements especially in facing a debilitating outbreak such as COVID-19. This study aims to explore public perspective on health systems' response towards COVID-19, and to identify gaps for health systems strengthening by leveraging on WHO health systems' building blocks. A qualitative study was conducted using open-ended questions survey among public followed by in-depth interviews with key informants. Opinions on Malaysia's health systems response towards COVID-19 were gathered. Data were exported to NVIVO version 12 and analysed using content analysis approach. The study identified various issues on health systems' response towards COVID-19, which were then mapped into health systems' building blocks. The study showed the gaps were embedded among complex interactions between the health systems building blocks. The leadership and governance building block had cross-cutting effects, and all building blocks influenced service deliveries. Understanding the complexities in fostering whole-systems strengthening through a holistic measure in facing an outbreak was paramount. Applying systems thinking in addressing gaps could help addressing the complexity at a macro level, including consideration of how an action implicates other building blocks and approaching the governance effort in a more adaptive manner to develop resilient systems.
    Matched MeSH terms: Disease Outbreaks
  11. Baderol Allam FN, Ab Hamid MR, Buhari SS, Md Noor H
    J Med Internet Res, 2021 03 15;23(3):e22465.
    PMID: 33720036 DOI: 10.2196/22465
    BACKGROUND: Hypertension is the root cause of many chronic diseases. Lifestyle changes (ie, dietary alterations and physical activity) are seen to be an important step in the prevention and treatment of hypertension. Educating people through web-based interventional programs could offer an effective solution and help these patients with hypertension in the existing health care scenario.

    OBJECTIVE: In this study, the researchers conducted a scoping literature review of the web-based dietary changes and physical activity-related intervention programs designed for the patients with hypertension and identified the methodologies, effectiveness, protocols, and theories, which could affect and improve existing clinical activities.

    METHODS: This review followed the scoping review methodology to identify and process the peer-reviewed studies published between 2010 and 2020. The literature searches were conducted on the following electronic databases: PubMed, Web of Science, MEDLINE (Medical Literature Analysis and Retrieval System Online), ScienceDirect, Scopus, and Google Scholar. By using relevant search terms, studies were included if they offered information related to the web-based intervention tools, specifically dietary and physical activity intervention for patients with hypertension. Studies written or translated in English language and published within the date range (January 2010 to March 2020) were included.

    RESULTS: Overall, 1441 articles were initially identified. The reviewers included 35 articles after removing duplicates and screening titles. Only 21 articles were assessed for full review, and 15 were kept for analysis. The researchers selected 15 web-based intervention articles published on the topic of hypertension from 7 countries. A few of these 15 web-based tools (4, 27%) included more than 3 functions and provided a lot of important information (such as appointments, health records, or viewable care). Several tools were standalone tools (11, 73%), while most of the tools supported communication intervention-related lifestyle or behavioral changes (13, 87%) and medication adherence (6, 40%). It was found that physicians (9, 60%), allied health professionals (5, 33%), and nurses (5, 33%) were the health care providers who generally used these tools for communicating with their patients. More than half of the above tools (10, 67%) were assessed by different researchers in randomized controlled trials, while 5 tools (33%) were investigated in nonrandomized studies.

    CONCLUSIONS: We identified many web-based intervention programs for patients with hypertension from the literature databases. The findings indicate that numerous benefits can be derived after using a web-based dietary and physical activity intervention program for hypertension focusing on lifestyle changes. However, developers need to consider the preferences of the patients with regard to the information or the design features while developing or modifying web-based educational websites. These tools could be used for designing a patient-tailored website intervention program that is based on diet and physical activities for patients with hypertension.

    Matched MeSH terms: Chronic Disease
  12. Ganasegeran K, Jamil MFA, Ch'ng ASH, Looi I, Peariasamy KM
    Int J Environ Res Public Health, 2021 Sep 18;18(18).
    PMID: 34574790 DOI: 10.3390/ijerph18189866
    The rapid transmission of highly contagious infectious diseases within communities can yield potential hotspots or clusters across geographies. For COVID-19, the impact of population density on transmission models demonstrates mixed findings. This study aims to determine the correlations between population density, clusters, and COVID-19 incidence across districts and regions in Malaysia. This countrywide ecological study was conducted between 22 January 2021 and 4 February 2021 involving 51,476 active COVID-19 cases during Malaysia's third wave of the pandemic, prior to the reimplementation of lockdowns. Population data from multiple sources was aggregated and spatial analytics were performed to visualize distributional choropleths of COVID-19 cases in relation to population density. Hierarchical cluster analysis was used to synthesize dendrograms to demarcate potential clusters against population density. Region-wise correlations and simple linear regression models were deduced to observe the strength of the correlations and the propagation effects of COVID-19 infections relative to population density. Distributional heats in choropleths and cluster analysis showed that districts with a high number of inhabitants and a high population density had a greater number of cases in proportion to the population in that area. The Central region had the strongest correlation between COVID-19 cases and population density (r = 0.912; 95% CI 0.911, 0.913; p < 0.001). The propagation effect and the spread of disease was greater in urbanized districts or cities. Population density is an important factor for the spread of COVID-19 in Malaysia.
    Matched MeSH terms: Communicable Disease Control
  13. Chai , W.L., Ngeow, W.C.
    Ann Dent, 1998;5(1):-.
    MyJurnal
    This paper revisits the prescription of drugs for pregnant patients and the dental and oral changes during pregnancy. The management of these patients is also outlined. Emphasis should be placed on prevention of dental problem during pregnancy.
    Matched MeSH terms: Disease Management
  14. Pahrudin Arrozi A, Shukri SNS, Wan Ngah WZ, Mohd Yusof YA, Ahmad Damanhuri MH, Makpol S
    Appl Biochem Biotechnol, 2017 Nov;183(3):853-866.
    PMID: 28417423 DOI: 10.1007/s12010-017-2468-6
    Neuroblastoma cell lines such as SH-SY5Y are the most frequently utilized models in neurodegenerative research, and their use has advanced the understanding of the pathology of neurodegeneration over the past few decades. In Alzheimer's disease (AD), several pathogenic mutations have been described, all of which cause elevated levels of pathological hallmarks such as amyloid-beta (Aβ). Although the genetics of Alzheimer's disease is well known, familial AD only accounts for a small number of cases in the population, with the rest being sporadic AD, which contains no known mutations. Currently, most of the in vitro models used to study AD pathogenesis only examine the level of Aβ42 as a confirmation of successful model generation and only perform comparisons between wild-type APP and single mutants of the APP gene. Recent findings have shown that the Aβ42/40 ratio in cerebrospinal fluid (CSF) is a better diagnostic indicator for AD patients than is Aβ42 alone and that more extensive Aβ formation, such as accumulation of intraneuronal Aβ, Aβ plaques, soluble oligomeric Aβ (oAβ), and insoluble fibrillar Aβ (fAβ) occurs in TgCRND8 mice expressing a double-mutant form (Swedish and Indiana) of APP, later leading to greater progressive impairment of the brain. In this study, we generated SH-SY5Y cells stably transfected separately with wild-type APP, the Swedish mutation of APP, and the Swedish and Indiana mutations of APP and evaluated the APP expression as well as the Aβ42/40 ratio in those cells. The double-mutant form of APP (Swedish/Indiana) expressed markedly high levels of APP protein and showed a high Aβ2/40 ratio compared to wild-type and single-mutant cells.
    Matched MeSH terms: Alzheimer Disease/genetics; Alzheimer Disease/metabolism; Alzheimer Disease/pathology*
  15. Ayiesah Ramli, Roslina Abdul Manap, Joseph, Leonard
    MyJurnal
    This study was aimed at identifying the effectiveness of hospital-based pulmonary rehabilitation programme as compared to home-based pulmonary programme in improving the condition of the chronic obstructive pulmonary disease (COPD) patients of Universiti Kebangsaan Malaysia Hospital. A total of 35 patients aging between 17 to 78 years old were randomised either to hospital (48.6%, n = 20) or home (43%, n = 15) -based pulmonary rehabilitation by the Physiotherapists. For the hospital-based rehabilitation programme, the patients were scheduled to come to the hospital twice a week for eight weeks. For home-based rehabilitation programme, subjects were scheduled to come to the Physiotherapy Department twice to learn on the exercises that need to be carried out before they are allowed to do on their own at home. Each subject was given a diary to record the exercises that have been done. A telephone call is made once a week for monitoring purpose. Assessment of lung function, six-minute-walk test and Borg score were carried out before and after the eight-week rehabilitation is conducted. The Results showed that there was no significant change in lung function for both groups before and after rehabilitation. There is a significant different (p < 0.05) in 6MWT before and after rehabilitation for hospital-based pulmonary rehabilitation patients. However, the difference is not significant (p > 0.05) for home-base pulmonary rehabilitation patients. The results also show that there exist no significant correlation between lung function and 6MWT even though there is an increase in walking distance at baseline or the eighth week. In conclusion, hospitalbased pulmonary rehabilitation is more effective than the home-based pulmonary rehabilitation in improving the exercise endurance which would helps in reduce dyspnoea among COPD patients.
    Keywords: Home-based pulmonary programme; Hospital-based pulmonary programme; COPD; Lung function
    Matched MeSH terms: Pulmonary Disease, Chronic Obstructive
  16. Mohd Ridzwan, J., Rafidah, B.
    MyJurnal
    Bipolar Mood Disorder (BMD) is one of the most common, severe, and persistent mental illnesses. The Malaysian Consensus Statement for the Treatment of Bipolar Mood Disorder, published in 2007 is still the major reference for managing the condition in this country. However, recently the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines was revised and at the moment, this contains the most up-to-date recommendations. This paper reviewed and compared both documents to establish the latest information on managing Bipolar Mood Disorder.
    Matched MeSH terms: Chronic Disease
  17. Norly Salleh, Aishah Ibrahim, Ros’aini Paijan
    MyJurnal
    Leiomyosarcoma is a rare cancer and the presence of this type of cancer in the breast is even rarer. Due to its rarity, the management options for leiomyosarcoma of the breast are not well documented. Literature review was done to establish the best treatment options for this type of breast cancer.
    Matched MeSH terms: Disease Management
  18. Lili Husniati Yaacob, Azlina Ishak
    MyJurnal
    This case illustrates the role of a woman's autonomy in deciding her medical management and the ethical issue which occurred when a husband refuses the management for her even though it was clearly indicated.
    Matched MeSH terms: Disease Management
  19. Wilhelmsen L
    Med J Malaysia, 1977 Jun;31(4):296-301.
    PMID: 927236
    Matched MeSH terms: Coronary Disease/blood; Coronary Disease/etiology; Coronary Disease/prevention & control*
  20. Aziz, N.A., Ramymond, A.A.
    Medicine & Health, 2008;3(1):1-6.
    MyJurnal
    Stroke is becoming a major public health issue in our country due to the fact that there isan increasing life span of our population. Due to advancement of acute management of stroke, three out of four people will survive beyond the acute phase of stroke. Stroke careproviders are still debating regarding the exact period of the terminology ‘longer-term stroke’; however many agreed that long-term of stroke refers to the period of one year and thereafter as this period is the determinant for longer-term survival. Management beyond the first year of stroke is complex, encompasses all aspects of patient’s life; physical, psychological and integration into community. Rehabilitation being the cornerstone of longer-term stroke management should now focused on more evidence-based approach as to be effective and relevant to the stroke patients.
    Matched MeSH terms: Disease Management
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