Displaying publications 41 - 60 of 105 in total

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  1. Fairuz MZ, Aiyub Z, Abdullah Z, Ng SW
    PMID: 21201779 DOI: 10.1107/S1600536808026317
    The two aromatic rings of each of the four independent molecules in the asymmetric unit of the title compound, C(11)H(9)ClN(2), are approximately coplanar; the four mol-ecules are arranged into two amino-pyridyl N-H⋯N hydrogen-bonded pairs. The structure has a 15% twin component related by a twofold rotation about [100].
  2. N Al-Mohammed N, Alias Y, Abdullah Z, Khaledi H
    Acta Crystallogr Sect E Struct Rep Online, 2011 May 1;67(Pt 5):o1043.
    PMID: 21754370 DOI: 10.1107/S1600536811011822
    In the title compound, C(29)H(24)N(4)O(4)S(3), the two N-tosyl-benzimidazolyl unit are connected through a -S-CH(2)- fragment, the dihedral angle between the benzimidazole rings being 76.09 (5)°. The methyl-thio group is disordered with respect to exchange of the S and C atoms in a 0.547 (4):0.453 (4) ratio. In the crystal, C-H⋯O and C-H⋯π inter-actions connect adjacent mol-ecules into infinite layers parallel to the ab plane. The crystal packing is further stabilized by a π-π inter-action [centroid-centroid separation = 3.5187 (4) Å].
  3. N Al-Mohammed N, Alias Y, Abdullah Z, Khaledi H
    Acta Crystallogr Sect E Struct Rep Online, 2011 Jul 1;67(Pt 7):o1701.
    PMID: 21837097 DOI: 10.1107/S1600536811022094
    In the title compound, C(13)H(23)N(2)O(2) (+)·Br(-), the octyl chain has an all-trans conformation. In the crystal, the cations are linked by C-H⋯O bonds into a zigzag chain along the b axis. The bromide anions further link the chains via C-H⋯Br inter-actions into a two-dimensional array parallel to the ab plane. An O-H⋯Br interaction is also observed.
  4. Yaeghoobi M, Khaledi H, Abdullah Z, Abd Rahman N
    Acta Crystallogr Sect E Struct Rep Online, 2011 Jul 1;67(Pt 7):o1693.
    PMID: 21837090 DOI: 10.1107/S1600536811022112
    In the title compound, C(21)H(19)NOS, the three aromatic rings are not coplanar, the dihedral angles between them being 84.75 (7), 88.01 (8) and 8.36 (16)°. In the crystal, two types of C-H⋯ π inter-actions, one of which is weak, and N-H⋯π inter-actions link the mol-ecules into layers parallel to the ab plane.
  5. N Al-Mohammed N, Alias Y, Abdullah Z, Khaledi H
    Acta Crystallogr Sect E Struct Rep Online, 2011 Jul 1;67(Pt 7):o1666.
    PMID: 21837065 DOI: 10.1107/S1600536811022082
    The title butterfly-shaped mol-ecule, C(11)H(6)N(2)O(2), is folded slightly along the O=C⋯C=O line, the dihedral angle between the two parts being 6.42 (3)°. In the crystal, adjacent mol-ecules are linked through C-H⋯O hydrogen bonds into infinite layers parallel to the ac plane. The layers are further connected into a three-dimensional netweork via π-π inter-actions formed between pairs of anti-parallel arranged mol-ecules, with a centroid-centroid distance between the central six-membered ring and the benzene ring of 3.4349 (9) Å.
  6. Abdullah Z, Tahir NM, Abas MR, Aiyub Z, Low BK
    Molecules, 2004 Jun 30;9(7):520-6.
    PMID: 18007451
    The reactions of 2-chloropyrimidine with methylamine, ethylamine and piperidine gave the corresponding 2-N-methylamino-, 2-N-ethylamino- and 2N- piperidinopyrimidines, respectively. The fluorescence properties of these alkylamino derivatives in chloroform, ethyl acetate, carbon tetrachloride, acetone, ether, ethanol and methanol were studied. All the alkylamino derivatives showed the highest fluorescence intensity in polar protic solvents; thus 2-N-methylaminopyrimidine (highest fluorescence intensity at 377 nm when excited at 282 nm) and 2-N-ethylaminopyrimidine (highest fluorescence intensity at 375 nm, when excited at 286 nm) showed the highest fluorescence in methanol. In ethanol, 2-N-piperidinopyrimidine showed a fluorescence peak at 403 nm when excited at 360 nm and in chloroform it fluoresced at 392 nm when excited at 356 nm.
  7. Abdo Qaid EY, Abdullah Z, Zakaria R, Long I
    Neurol Res, 2024 Mar;46(3):261-271.
    PMID: 38122814 DOI: 10.1080/01616412.2023.2296754
    INTRODUCTION: The neuroinflammatory response was seen to impact the formation of phosphorylated tau protein in Alzheimer's disease (AD). This study aims to investigate the molecular mechanism of minocycline in reducing phosphorylated tau protein formation in the hippocampus of lipopolysaccharide (LPS)-induced rats.

    METHODS: Fifty adult male Sprague Dawley (SD) rats were randomly allocated to 1 of 5 groups: control, LPS (5 mg/kg), LPS + minocycline (25 mg/kg), LPS + minocycline (50 mg/kg) and LPS + memantine (10 mg/kg). Minocycline and memantine were administered intraperitoneally (i.p) for two weeks, and LPS was injected i.p. once on day 5. ELISA was used to determine the level of phosphorylated tau protein in SD rats' hippocampal tissue. The density and expression of Toll-like receptor-4 (TLR-4), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-кβ), tumour necrosis factor-alpha (TNF-α), and cyclooxygenase (COX)-2 were determined using Western blot and immunohistochemistry.

    RESULTS: Minocycline, like memantine, prevented LPS-induced increasein phosphorylated tau protein level suggested via reduced density and expression of TLR-4, NF-кβ, TNF-αand COX-2 proteins in rat hippocampal tissue. Interestingly, higher doses were shown to be more neuroprotective than lower doses.

    CONCLUSION: This study suggests that minocycline suppresses the neuroinflammation signalling pathway and decreased phosphorylated tau protein formation induced by LPS in a dose-dependent manner. Minocycline can be used as a preventative and therapeutic drug for neuroinflammatory diseases such as AD.

  8. Abdo Qaid EY, Abdullah Z, Zakaria R, Long I
    Int J Neurosci, 2024 Jun;134(1):56-65.
    PMID: 35638219 DOI: 10.1080/00207454.2022.2084092
    PURPOSE/AIM: Neuroinflammation and oxidative stress have been encountered in neurodegenerative diseases such as Alzheimer's disease (AD). However, the neuroprotective effects of minocycline against lipopolysaccharide (LPS)-induced glial cells activation and oxidative stress damage in the medial prefrontal cortex (mPFC) of rats are still elusive. The purpose of this study is to investigate the effects of minocycline and memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist, on the microglia and astrocytes expression, as well as oxidative stress levels in the mPFC of LPS injected rats.

    MATERIALS AND METHODS: Fifty adult Male Sprague Dawley rats were divided into five groups: control, LPS (5 mg/kg), LPS treated with minocycline (25 mg/kg), LPS treated with minocycline (50 mg/kg) and LPS treated with memantine (10 mg/kg). The immunohistochemistry and western blotting were used to analyse the expressions and densities of microglia marker (Iba-1) and astrocyte marker, (GFAP) while enzyme-linked immunosorbent assay (ELISA) was used to measure the protein carbonyl (PCO), malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD) levels.

    RESULTS: In comparison to the control group, the expression and density of Iba-1 and GFAP were significantly enhanced in the LPS group (p 

  9. Aznan AM, Abdullah Z, Lee VS, Tiekink ER
    Acta Crystallogr Sect E Struct Rep Online, 2014 Aug 1;70(Pt 8):58-61.
    PMID: 25249854 DOI: 10.1107/S1600536814012227
    The title compound, C12H11N3O2, is a second monoclinic polymorph (P21, with Z' = 4) of the previously reported monoclinic (P21/c, with Z' = 2) form [Akhmad Aznan et al. (2010 ▶). Acta Cryst. E66, o2400]. Four independent mol-ecules comprise the asymmetric unit, which have the common features of a syn disposition of the pyridine N atom and the toluene ring, and an intra-molecular amine-nitro N-H⋯O hydrogen bond. The differences between mol-ecules relate to the dihedral angles between the rings which range from 2.92 (19) to 26.24 (19)°. The geometry-optimized structure [B3LYP level of theory and 6-311 g+(d,p) basis set] has the same features except that the entire mol-ecule is planar. In the crystal, the three-dimensional architecture is consolidated by a combination of C-H⋯O, C-H⋯π, nitro-N-O⋯π and π-π inter-actions [inter-centroid distances = 3.649 (2)-3.916 (2) Å].
  10. Akhmad Aznan AM, Abdullah Z, Tiekink ER
    PMID: 25161500 DOI: 10.1107/S1600536814011532
    The 1:1 co-crystallization of 1,4-di-aza-bicyclo-[2.2.2]octane (DABCO) with 4-nitro-benzoic acid in ethanol-water (3/1) gave the salt dihydrate C6H13N2 (+)·C7H4NO4 (-)·2H2O, (1), whereas from methanol, the salt C6H14N2 (2+)·2C7H4NO4 (-), (2), was isolated. In (1), the cation and anion are linked by a strong N-H⋯O hydrogen bond, and the carboxyl-ate anion is close to planar [dihedral angle between terminal residues = 6.83 (9)°]. In (2), a three-ion aggregate is assembled by two N-H⋯O hydrogen bonds, and the carboxyl-ate anions are again close to planar [dihedral angles between terminal residues = 1.7 (3) and 5.9 (3)°]. Through the inter-vention of solvent water mol-ecules, which self-assemble into helical supra-molecular chains along the b axis, the three-dimensional architecture in (1) is stabilized by water-DABCO O-H⋯N and water-carboxyl-ate O-H⋯O hydrogen bonds, with additional stability afforded by C-H⋯O inter-actions. The global crystal structure comprises alternating layers of water mol-ecules and ion pairs stacked along the c axis. In the crystal of (2), the three-ion aggregates are assembled into a three-dimensional architecture by a large number of methyl-ene-carboxyl-ate/nitro C-H⋯O inter-actions as well as π-π contacts between inversion-related benzene rings [inter-centroid distances = 3.5644 (16) and 3.6527 (16) Å]. The cations and anions assemble into alternating layers along the c axis.
  11. Ismail IN, Asri NI, Tajuddin HA, Abdullah Z
    J Fluoresc, 2015 Jul;25(4):777-85.
    PMID: 26054802 DOI: 10.1007/s10895-015-1587-0
    A coumarin-terminated self-assembled monolayer on silver particles (C-SAM) from the reduction of silver ions in the presence of compound 3 was successfully prepared by utilizing phase transfer method, and analyzed by FTIR, SEM-EDS, UV-Visible and a particle sizer. The fluorescence behavior of coumarin termini was carried out in ethanol and chloroform with emission wavelength determined at 386 nm, suggesting an interaction between the carbonyl group and the solvent media. The dispersion was then investigated in acidic and basic conditions, showing a direct proportional correlation between the emission and the pH of the aqueous. These results were consistent for interpreting hydrogen bonds, particularly between the carbonyl group with either proton of the alcohol (C=O----H-O-R) or positive species in acidic conditions (C=O----H(+)). The interactions were possible only when the coumarin terminal rearranged in the monolayer and the carbonyl exerted towards the solvent media, while the rest of the molecules were separated from the solvents.
  12. Abdo Qaid EY, Abdullah Z, Zakaria R, Long I
    Int J Mol Sci, 2022 Nov 03;23(21).
    PMID: 36362262 DOI: 10.3390/ijms232113474
    Neuroinflammation following lipopolysaccharide (LPS) administration induces locomotor deficits and anxiety-like behaviour. In this study, minocycline was compared to memantine, an NMDA receptor antagonist, for its effects on LPS-induced locomotor deficits and anxiety-like behaviour in rats. Adult male Sprague Dawley rats were administered either two different doses of minocycline (25 or 50 mg/kg/day, i.p.) or 10 mg/kg/day of memantine (i.p.) for 14 days four days prior to an LPS (5 mg/kg, i.p.) injection. Locomotor activity and anxiety-like behaviour were assessed using the open-field test (OFT). The phosphorylated tau protein level was measured using ELISA, while the expression and density of brain-derived neurotrophic factor (BDNF) and cAMP response element-binding (CREB) protein in the medial prefrontal cortex (mPFC) were measured using immunohistochemistry and Western blot, respectively. Minocycline treatment reduced locomotor deficits and anxiety-like behaviour associated with reduced phosphorylated tau protein levels, but it upregulated BDNF/CREB protein expressions in the mPFC in a comparable manner to memantine, with a higher dose of minocycline having better benefits. Minocycline treatment attenuated LPS-induced locomotor deficits and anxiety-like behaviour in rats and decreased phosphorylated tau protein levels, but it increased the expressions of the BDNF/CREB proteins in the mPFC.
  13. Qaid EYA, Abdullah Z, Zakaria R, Long I
    Neurochem Res, 2023 May;48(5):1480-1490.
    PMID: 36509985 DOI: 10.1007/s11064-022-03842-3
    The oxidative stress-induced dysregulation of the cyclic AMP response element-binding protein- brain-derived neurotrophic factor (CREB-BDNF) cascade has been linked to cognitive impairment in several studies. This study aimed to investigate the effect of minocycline on the levels of oxidative stress markers, CREB, and BDNF in lipopolysaccharide (LPS)-induced cognitive impairment. Fifty adult male Sprague Dawley rats were divided randomly into five groups. Group 1 was an untreated control group. Groups 2, 3, 4 and 5 were treated concurrently with LPS (5 mg/kg, i.p) once on day 5 and normal saline (0.7 ml/rat, i.p) or minocycline (25 and 50 mg/kg, i.p) or memantine (10 mg/kg, i.p) once daily from day 1 until day 14, respectively. From day 15 to day 22 of the experiment, Morris Water Maze (MWM) was used to evaluate learning and reference memory in rats. The levels of protein carbonyl (PCO), malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD) were determined by enzyme-linked immunosorbent assay (ELISA). CREB and BDNF expression and density were measured by immunohistochemistry and western blot analysis, respectively. LPS administration significantly increased escape latency to the hidden platform with decreased travelled distance, swimming speed, target crossings and time spent in the target quadrant. Besides, the hippocampal tissue of LPS rats showed increased levels of PCO and MDA, decreased levels of CAT and SOD, and reduced expression and density of BDNF and CREB. Treatment with minocycline reversed these effects in a dose-dependent manner, comparable to the effects of memantine. Both doses of minocycline treatment protect against LPS-induced cognitive impairment by reducing oxidative stress and upregulating the CREB-BDNF signalling pathway in the rat hippocampus.
  14. Abdo Qaid EY, Abdullah Z, Zakaria R, Long I
    J Mol Histol, 2025 Apr 25;56(3):138.
    PMID: 40274650 DOI: 10.1007/s10735-025-10419-1
    Minocycline has been shown to ameliorate neuroinflammation that was encountered in many neurodegenerative diseases. This study aims to investigate the expression of inflammatory mediators in the rat medial prefrontal cortex (mPFC) after minocycline treatment in a lipopolysaccharide (LPS)- induced neuroinflammation rat model. Adult male Sprague Dawley (SD) rats (N = 50) were divided into 5 groups: (1) control, (2) LPS (5 mg/kg), (3) LPS + minocycline (25 mg/kg), (4) LPS + minocycline (50 mg/kg) and (5) LPS + memantine (10 mg/kg). Intraperitoneal minocycline and memantine were given daily for 14 days, while LPS injection was given once on the 5th day. Western blot and immunohistochemistry were used to assess density and expression of toll-like receptor-4 (TLR-4), nuclear factor kappa-B (NF-kB), tumor necrosis factor (TNF)-α and cyclooxygenase (COX)-2 in the medial prefrontal cortex (mPFC) of rats. Findings displayed that minocycline significantly decreased expression and density of TLR-4, NF-kB, TNF-α and COX-2 proteins that were comparable to memantine in mPFC of SD rat injected with single intraperitoneal LPS. Interestingly, the anti-inflammatory effects of minocycline 50 mg/kg were significantly more than minocycline 25 mg/kg. This study suggested that minocycline can modulate LPS-induced neuroinflammation in dose-dependent manner in the mPFC area. Thus, it is suggested that minocycline can be used as potential preventive-therapeutic drug for neuroinflammatory diseases such as depression and anxiety.
  15. Fadaeinasab M, Karimian H, Omar H, Taha H, Khorasani A, Banisalam B, et al.
    J Asian Nat Prod Res, 2020 May;22(5):474-488.
    PMID: 30945944 DOI: 10.1080/10286020.2019.1588888
    One new indole alkaloid, reflexin A (1), and two known indoles, macusine B (2) and vinorine (3), were isolated from the bark of Rauvolfia reflexa. Their structures were elucidated by 1D and 2D NMR, UV, IR, and MS spectroscopic analyses. Compound 1 displayed anticancer activity against HCT-116 colon cancer cells with an IC50 value of 30.24 ± 0.75 µM. The results implied that the newly isolated 1 induced apoptosis in HCT-116 cells, suggesting its possible role as an anticancer agent. In vivo acute toxicity study was performed on compound 1 to evaluate its safety profile.
  16. Mazlun MH, Sabran SF, Mohamed M, Abu Bakar MF, Abdullah Z
    Molecules, 2019 Jul 04;24(13).
    PMID: 31277371 DOI: 10.3390/molecules24132449
    Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB) remains one of the deadliest, infectious diseases worldwide. The detrimental effects caused by the existing anti-TB drugs to TB patients and the emergence of resistance strains of M. tuberculosis has driven efforts from natural products researchers around the globe in discovering novel anti-TB drugs that are more efficacious and with less side effects. There were eleven main review publications that focused on natural products with anti-TB potentials. However, none of them specifically emphasized antimycobacterial phenolic compounds. Thus, the current review's main objective is to highlight and summarize phenolic compounds found active against mycobacteria from 2000 to 2017. Based on the past studies in the electronic databases, the present review also focuses on several test organisms used in TB researches and their different distinct properties, a few types of in vitro TB bioassay and comparison between their strengths and drawbacks, different methods of extraction, fractionation and isolation, ways of characterizing and identifying isolated compounds and the mechanism of actions of anti-TB phenolic compounds as reported in the literature.
  17. Muhamad Sarih N, Myers P, Slater A, Slater B, Abdullah Z, Tajuddin HA, et al.
    Sci Rep, 2019 08 14;9(1):11834.
    PMID: 31413269 DOI: 10.1038/s41598-019-47847-5
    Three fluorescent organic compounds-furocoumarin (FC), dansyl aniline (DA), and 7-hydroxycoumarin-3-carboxylic acid (CC)-are mixed to produce almost pure white light emission (WLE). This novel mixture is immobilised in silica aerogel and applied as a coating to a UV LED to demonstrate its applicability as a low-cost, organic coating for WLE via simultaneous emission. In ethanol solution and when immobilised in silica aerogel, the mixture exhibits a Commission Internationale d'Eclairage (CIE) chromaticity index of (0.27, 0.33). It was observed that a broadband and simultaneous emission involving coumarin carboxylic acid, furocoumarin and dansyl aniline played a vital role in obtaining a CIE index close to that of pure white light.
  18. Abdullah Z, Abdul Aziz SH, Sodri NA, Mohd Hanafiah AN, Ibrahim NI, Johari MZ
    J Prim Care Community Health, 2020 10 23;11:2150132720956478.
    PMID: 33089737 DOI: 10.1177/2150132720956478
    BACKGROUND: Primary healthcare is the earliest gateway for patient care, and improvisations are often needed to accommodate the ever-increasing demand in public health. The Enhanced Primary Healthcare (EnPHC) initiative is aimed at improving such needs, and one core intervention is the introduction of a care coordinator (CC). The purpose of this study was to identify barriers and facilitators in implementing a new intervention in primary healthcare clinics.

    METHODS: This qualitative exploration study. All healthcare providers who were involved in EnPHC at the intervention clinics were selected as participants. In-depth interviews and focus group discussions were carried out among healthcare providers working in the intervention clinic. Thematic analysis was used to categorize data, based on the consolidated framework for implementation research (CFIR) theoretical framework domains.

    RESULTS: A total of 61 healthcare providers participated. All 5 domains with 19 CFIR constructs emerged from the analysis. Inner setting played a significant role in facilitating CC intervention, in which culture, networking, and collaboration and leadership engagement played an essential role in supporting CC activities. Although CC tasks are complex, concerns of losing clinical skill and resource constraints were identified as potential barriers in CC implementations. Criteria for appointing new CCs emerged from the characteristics of individual constructs, in which the individual must be familiar and interested in community health, have good communication skills, and at least 3 years' experience in the primary healthcare setting.

    CONCLUSION: The implementation of the CC intervention faces varying challenges in different settings. This is partially resolved through teamwork, guidance from mentors, and support from superiors. The complexity of the responsibility of the CC intervention is perceived as both a validation and a burden. Above all, it is seen as paramount in EnPHC intervention.

  19. Sarih NM, Ciupa A, Moss S, Myers P, Slater AG, Abdullah Z, et al.
    Sci Rep, 2020 May 04;10(1):7421.
    PMID: 32366859 DOI: 10.1038/s41598-020-63262-7
    Furocoumarin (furo[3,2-c]coumarin) derivatives have been synthesized from single step, high yielding (82-92%) chemistry involving a 4-hydroxycoumarin 4 + 1 cycloaddition reaction. They are characterized by FTIR, 1H-NMR, and, for the first time, a comprehensive UV-Vis and fluorescence spectroscopy study has been carried out to determine if these compounds can serve as useful sensors. Based on the fluorescence data, the most promising furocoumarin derivative (2-(cyclohexylamino)-3-phenyl-4H-furo[3,2-c]chromen-4-one, FH), exhibits strong fluorescence (ФF = 0.48) with long fluorescence lifetime (5.6 ns) and large Stokes' shift, suggesting FH could be used as a novel fluorescent chemosensor. FH exhibits a highly selective, sensitive and instant turn-off fluorescence response to Fe3+ over other metal ions which was attributed to a charge transfer mechanism. Selectivity was demonstrated against 13 other competing metal ions (Na+, K+, Mg2+, Ca2+, Mn2+, Fe2+, Al3+, Ni2+, Cu2+, Zn2+, Co2+, Pb2+ and Ru3+) and aqueous compatibility was demonstrated in 10% MeOH-H2O solution. The FH sensor coordinates Fe3+ in a 1:2 stoichiometry with a binding constant, Ka = 5.25 × 103 M-1. This novel sensor has a limit of detection of 1.93 µM, below that of the US environmental protection agency guidelines (5.37 µM), with a linear dynamic range of ~28 (~2-30 µM) and an R2 value of 0.9975. As an exemplar application we demonstrate the potential of this sensor for the rapid measurement of Fe3+ in mineral and tap water samples demonstrating the real-world application of FH as a "turn off" fluorescence sensor.
  20. Johari MZ, Abdullah Z, Mohd Hanafiah AN, Mohammed Nadzri NI, Razli SA, Kong YL
    BMC Fam Pract, 2020 09 04;21(1):182.
    PMID: 32887562 DOI: 10.1186/s12875-020-01254-2
    BACKGROUND: Implementation of the new Enhanced Primary Health Care (EnPHC) intervention aims to improve service quality and experience at primary healthcare clinics; especially to newly diagnosed patients. This was achieved by restructuring and improving existing services to better manage non-communicable diseases amongst patients. Objectives of this study are to explore patients' experiences of the EnPHC intervention, to document their feedback and to determine effects of EnPHC intervention on patients.

    METHODS: This phenomenological qualitative study focussed on patients' experiences in relation to EnPHC interventions. Participants were purposely selected from a group of patients who attended the eight intervention primary healthcare clinics in Johor and Selangor regularly for treatment. Data collection was conducted between April to July 2018. Semi-structured interviews were conducted at average an hour per interview for four to five patients per clinic. Interviews were audio recorded, transcribed verbatim, coded and analysed using a thematic analysis approach.

    RESULTS: A total of 35 patients participated. Analysis revealed five main themes about patient experiences receiving the EnPHC intervention. These are: (1) health assessment in disease progress monitoring, (2) patient-doctor relationship and continuity of care, (3) professionalism in service delivery, (4) ensuring compliance in achieving health targets and (5) communication skills. Each theme represents an important aspect of the service, how it should be delivered within the patient expectations and how it can improve patient's health through their lens.

    CONCLUSION: Even though patients were not able to exactly identify the EnPHC intervention components implemented, they are able to describe the process changes that occurred; enabling them to improve their healthcare status. Engagement is necessary to better inform patients of the EnPHC intervention, its purpose, mechanisms, changes and importance for healthcare. It would reduce resistance and increase awareness amongst patients at the clinic.

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