Displaying publications 41 - 60 of 131 in total

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  1. Fulltext A hybrid recommender system based on data enrichment on the ontology modelling
    Chew LJ, Haw SC, Subramaniam S
    F1000Res, 2021;10:937.
    PMID: 34868563 DOI: 10.12688/f1000research.73060.1
    Background: A recommender system captures the user preferences and behaviour to provide a relevant recommendation to the user. In a hybrid model-based recommender system, it requires a pre-trained data model to generate recommendations for a user. Ontology helps to represent the semantic information and relationships to model the expressivity and linkage among the data. Methods: We enhanced the matrix factorization model accuracy by utilizing ontology to enrich the information of the user-item matrix by integrating the item-based and user-based collaborative filtering techniques. In particular, the combination of enriched data, which consists of semantic similarity together with rating pattern, will help to reduce the cold start problem in the model-based recommender system. When the new user or item first coming into the system, we have the user demographic or item profile that linked to our ontology. Thus, semantic similarity can be calculated during the item-based and user-based collaborating filtering process. The item-based and user-based filtering process are used to predict the unknown rating of the original matrix. Results: Experimental evaluations have been carried out on the MovieLens 100k dataset to demonstrate the accuracy rate of our proposed approach as compared to the baseline method using (i) Singular Value Decomposition (SVD) and (ii) combination of item-based collaborative filtering technique with SVD. Experimental results demonstrated that our proposed method has reduced the data sparsity from 0.9542% to 0.8435%. In addition, it also indicated that our proposed method has achieved better accuracy with Root Mean Square Error (RMSE) of 0.9298, as compared to the baseline method (RMSE: 0.9642) and the existing method (RMSE: 0.9492). Conclusions: Our proposed method enhanced the dataset information by integrating user-based and item-based collaborative filtering techniques. The experiment results shows that our system has reduced the data sparsity and has better accuracy as compared to baseline method and existing method.
  2. Fulltext Improving the support for XML dynamic updates using a hybridization labeling scheme (ORD-GAP)
    Haw SC, Amin A, Wong CO, Subramaniam S
    F1000Res, 2021;10:907.
    PMID: 35106138 DOI: 10.12688/f1000research.69108.1
    Background : As the standard for the exchange of data over the World Wide Web, it is important to ensure that the eXtensible Markup Language (XML) database is capable of supporting not only efficient query processing but also capable of enduring frequent data update operations over the dynamic changes of Web content. Most of the existing XML annotation is based on a labeling scheme to identify each hierarchical position of the XML nodes. This computation is costly as any updates will cause the whole XML tree to be re-labelled. This impact can be observed on large datasets. Therefore, a robust labeling scheme that avoids re-labeling is crucial. Method: Here, we present ORD-GAP (named after Order Gap), a robust and persistent XML labeling scheme that supports dynamic updates. ORD-GAP assigns unique identifiers with gaps in-between XML nodes, which could easily identify the level, Parent-Child (P-C), Ancestor-Descendant (A-D) and sibling relationship. ORD-GAP adopts the OrdPath labeling scheme for any future insertion. Results: We demonstrate that ORD-GAP is robust enough for dynamic updates, and have implemented it in three use cases: (i) left-most, (ii) in-between and (iii) right-most insertion. Experimental evaluations on DBLP dataset demonstrated that ORD-GAP outperformed existing approaches such as ORDPath and ME Labeling concerning database storage size, data loading time and query retrieval. On average, ORD-GAP has the best storing and query retrieval time. Conclusion: The main contributions of this paper are: (i) A robust labeling scheme named ORD-GAP that assigns certain gap between each node to support future insertion, and (ii) An efficient mapping scheme, which built upon ORD-GAP labeling scheme to transform XML into RDB effectively.
  3. Fulltext Improving the data access control using blockchain for healthcare domain
    Tahir Yinka O, Haw SC, Yap TTV, Subramaniam S
    F1000Res, 2021;10:901.
    PMID: 34858590 DOI: 10.12688/f1000research.72890.3
    Introduction: Unauthorized access to data is one of the most significant privacy issues that hinder most industries from adopting big data technologies. Even though specific processes and structures have been put in place to deal with access authorization and identity management for large databases nonetheless, the scalability criteria are far beyond the capabilities of traditional databases. Hence, most researchers are looking into other solutions, such as big data management. Methods: In this paper, we firstly study the strengths and weaknesses of implementing cryptography and blockchain for identity management and authorization control in big data, focusing on the healthcare domain. Subsequently, we propose a decentralized data access and sharing system that preserves privacy to ensure adequate data access management under the blockchain. In addition, we designed a blockchain framework to resolve the decentralized data access and sharing system privacy issues, by implementing a public key infrastructure model, which utilizes a signature cryptography algorithm (elliptic curve and signcryption). Lastly, we compared the proposed blockchain model to previous techniques to see how well it performed. Results: We evaluated the blockchain on four performance metrics which include throughput, latency, scalability, and security. The proposed blockchain model was tested using a sample of 5000 patients and 500,000 observations. The performance evaluation results further showed that the proposed model achieves higher throughput and lower latency compared to existing approaches when the workload varies up to 10,000 transactions. Discussion: This research reviews the importance of blockchains as they provide infinite possibilities to individuals, companies, and governments.
  4. Fulltext OneHealth Approaches Contribute Towards Antimicrobial Resistance: Malaysian Perspective
    Mariappan V, Vellasamy KM, Mohamad NA, Subramaniam S, Vadivelu J
    Front Microbiol, 2021;12:718774.
    PMID: 34759896 DOI: 10.3389/fmicb.2021.718774
    On a global scale, antimicrobial resistance (AMR) is recognized as a One Health challenge due to the continual and increased development and distribution of resistant microbes and genes among humans, animals, and the environment. These sectors contribute to the increase in AMR, as antibiotics are widely used in healthcare to treat or prevent bacterial infection; as growth enhancers, therapeutics and metaphylactics in animal husbandry; and transmitted in the environment through irrigation using wastewater or inappropriate disposal and treatment of human and agricultural waste. However, there is a major drawback in terms of the lack of research assessing the coexistence of AMR in these sectors. Extensive research highlighted food-animal manufacture structures that are likely to harbor reservoirs or promote transmission of AMR, in addition to increasing human colonization with AMR commensal bacteria. Numerous antibiotic stewardship policies have been designed and implemented in medical practices and animal husbandry in high- and middle-income countries. However, research concentrating on high-income settings, attitudes, emotions, and beliefs on the utilization of antimicrobials remain underexplored in lower- and middle-income countries such as Malaysia. Microbiological, epidemiological, and social science exploration are required at community and farming across the One Health range to fill huge gaps in information and knowledge of AMR. Manipulating human activities and character associated with antibiotics is a multifaceted progression that includes elements like knowledge, social behavior, attitudes, approaches, social standards, socioeconomic settings, peer pressure, experiences, and biophysical environment. Therefore, understanding these aspects in the utilization of antimicrobial drugs among the different sectors is essential to develop and implement policies to curb AMR development and transmission that overarch all sectors within the One Health consortium in Malaysia.
  5. Fulltext Effect of aflatoxin B1 exposure on the progression of depressive-like behavior in rats
    Subramaniam S, Sabran MR, Stanslas J, Kirby BP
    Front Nutr, 2022;9:1032810.
    PMID: 36466381 DOI: 10.3389/fnut.2022.1032810
    While it is well documented that aflatoxin B1 (AFB1); one of the most toxic food contaminants is linked to the development of depression. However, the mechanism on how it affects the gut and brain health leading to depressive-like behavior remains unclear. This study was conducted to determine the effect of AFB1 on the progression of depressive-like behavior. Thirty-two (n = 32) male Sprague Dawley rats were randomly allocated into four groups: control, low-dose (5 μg AFB1/kg), high-dose (25 μg AFB1/kg) and positive control group; exposed on chronic unpredictable mild stress (CUMS). After 4 weeks of exposure, sucrose preference test (SPT) and force swim test (FST) were used to measure behavioral despair. Fecal samples were selectively cultured to profile the bacteria. Body weight and relative organs weights were compared among groups. AFB1 and CUMS caused reduction in body weight and food intake as well as increased relative weight of adrenal glands, liver, and brain. Rats in AFB1 and CUMS groups had suppressed sucrose preference and prolonged immobility time in FST, wherein this could indicate anhedonia. Besides, fecal count of Lactobacillus spp. was significantly low following AFB1 exposure, with increasing count of Bifidobacterium spp, in comparison to the control. Indeed, further biochemical analysis and metagenomic approach are warranted to explore the underlying mechanisms on the role of gut microbiota dysbiosis and dysregulation of gut-brain axis due to AFB1 neurotoxicity on the progression of depressive-like behavior.
  6. Fulltext A psychologist-led educational intervention results in a sustained reduction in neonatal intensive care unit infections
    Van Rostenberghe H, Short J, Ramli N, Geok TB, Subramaniam S, Che Yaakob CA, et al.
    Front Pediatr, 2014;2:115.
    PMID: 25478550 DOI: 10.3389/fped.2014.00115
    Even though in the corporate world psychological science has been widely used, the formal use of evidence-based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led 2-week nurse educator training on the infection rate in the neonatal intensive care unit (NICU).
  7. Fulltext In silico analysis of angiotensin-converting enzyme inhibitory compounds obtained from soybean [Glycine max (L.) Merr.]
    Ramlal A, Bhat I, Nautiyal A, Baweja P, Mehta S, Kumar V, et al.
    Front Physiol, 2023;14:1172684.
    PMID: 37324400 DOI: 10.3389/fphys.2023.1172684
    Cardiovascular diseases (CVDs) are one of the major reasons for deaths globally. The renin-angiotensin-aldosterone system (RAAS) regulates body hypertension and fluid balance which causes CVD. Angiotensin-converting enzyme I (ACE I) is the central Zn-metallopeptidase component of the RAAS playing a crucial role in maintaining homeostasis of the cardiovascular system. The available drugs to treat CVD have many side effects, and thus, there is a need to explore phytocompounds and peptides to be utilized as alternative therapies. Soybean is a unique legume cum oilseed crop with an enriched source of proteins. Soybean extracts serve as a primary ingredient in many drug formulations against diabetes, obesity, and spinal cord-related disorders. Soy proteins and their products act against ACE I which may provide a new scope for the identification of potential scaffolds that can help in the design of safer and natural cardiovascular therapies. In this study, the molecular basis for selective inhibition of 34 soy phytomolecules (especially of beta-sitosterol, soyasaponin I, soyasaponin II, soyasaponin II methyl ester, dehydrosoyasaponin I, and phytic acid) was evaluated using in silico molecular docking approaches and dynamic simulations. Our results indicate that amongst the compounds, beta-sitosterol exhibited a potential inhibitory action against ACE I.
  8. Fulltext One Health surveillance approaches for melioidosis and glanders: The Malaysian perspective
    Mariappan V, Vellasamy KM, Anpalagar RR, Lim YM, Zainal Abidin N, Subramaniam S, et al.
    Front Vet Sci, 2022;9:1056723.
    PMID: 36590813 DOI: 10.3389/fvets.2022.1056723
    The One Health concept was initiated to promote the integration of human, animal, and environmental ecosystems into healthcare to ensure effective control and the sustainable governance of multifaceted health matters. Climate change, deforestation, and rigorous farming disrupt the environment, which serves as the natural habitat for many animals and microbes, increasing the likelihood of disease transmission between humans and animals. Melioidosis (neglected tropical diseases) and glanders are of humans and animals caused by the gram-negative bacteria Burkholderia pseudomallei and its close relative Burkholderia mallei, respectively. In Malaysia, although melioidosis is endemic, it is not a notifiable disease. Hence, the true prevalence of melioidosis in Malaysia is unknown and varies in different regions of the country, with reported hotspots associated with agriculture-related activities. To date, no incidence of human glanders has been reported in Malaysia, although occupational exposure for equine handlers and veterinary professionals remains a concern. Additionally, antibiotics are widely used in the healthcare and veterinary sectors to treat or prevent B. pseudomallei and B. mallei infections, leading to the emergence of resistance in B. pseudomallei. Lack of surveillance, research, assessment, and management of glanders and melioidosis is a major issue in Malaysia. Proper assessment systems and cross-discipline cooperation are vital to recognize and manage both diseases. Experts and practitioners from clinical and veterinary disciplines, environmentalists, law enforcement, policymakers, researchers, local communities, and other experts need to communicate, collaborate, and coordinate activities to fill the knowledge gap on glanders and melioidosis to reduce morbidity and mortality rates in the country. This review aims to define the organizational and functional characteristics of One Health surveillance approaches for glanders and melioidosis from a Malaysian perspective.
  9. Fulltext Transcriptome Profiling of Haloxylon persicum (Bunge ex Boiss and Buhse) an Endangered Plant Species under PEG-Induced Drought Stress
    Thayale Purayil F, Rajashekar B, S Kurup S, Cheruth AJ, Subramaniam S, Hassan Tawfik N, et al.
    Genes (Basel), 2020 06 10;11(6).
    PMID: 32531994 DOI: 10.3390/genes11060640
    Haloxylon persicum is an endangered western Asiatic desert plant species, which survives under extreme environmental conditions. In this study, we focused on transcriptome analysis of H. persicum to understand the molecular mechanisms associated with drought tolerance. Two different periods of polyethylene glycol (PEG)-induced drought stress (48 h and 72 h) were imposed on H. persicum under in vitro conditions, which resulted in 18 million reads, subsequently assembled by de novo method with more than 8000 transcripts in each treatment. The N50 values were 1437, 1467, and 1524 for the control sample, 48 h samples, and 72 h samples, respectively. The gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis resulted in enrichment of mitogen-activated protein kinase (MAPK) and plant hormone signal transduction pathways under PEG-induced drought conditions. The differential gene expression analysis (DGEs) revealed significant changes in the expression pattern between the control and the treated samples. The KEGG analysis resulted in mapping transcripts with 138 different pathways reported in plants. The differential expression of drought-responsive transcription factors depicts the possible signaling cascades involved in drought tolerance. The present study provides greater insight into the fundamental transcriptome reprogramming of desert plants under drought.
  10. Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus
    Bhandari P, Subramaniam S, Bourke MJ, Alkandari A, Chiu PWY, Brown JF, et al.
    Gut, 2020 11;69(11):1915-1924.
    PMID: 32816921 DOI: 10.1136/gutjnl-2020-322329
    The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.
  11. Fulltext Maternal and perinatal guideline development in hospitals in South East Asia: results from the SEA-ORCHID project
    Thinkhamrop J, Turner T, Subramaniam S, SEA-ORCHID Study Group
    Health Res Policy Syst, 2009 May 08;7:9.
    PMID: 19422715 DOI: 10.1186/1478-4505-7-9
    Recognising the potential of clinical practice guidelines (CPGs) to improve practice, one of the strategies of the SEA-ORCHID project was to facilitate the development of evidence-based CPGs, and to support clinical staff in each of the four countries to build their skills in development of CPGs in the nine participating hospitals in Thailand, Malaysia, Philippines and Indonesia. This study was undertaken to investigate the impact of the SEA-ORCHID project on development of evidence-based CPGs.
  12. Fulltext Exploring faradaic and non-faradaic electrochemical impedance spectroscopy approaches in Parkinson's disease diagnosis
    Adam H, Gopinath SCB, Adam T, A Fakhri M, T Salim E, Subramaniam S
    Heliyon, 2024 Mar 15;10(5):e27433.
    PMID: 38495156 DOI: 10.1016/j.heliyon.2024.e27433
    Parkinson's disease is a neurodegenerative condition defined by the progressive death of dopaminergic neurons in the brain. The diagnosis of Parkinson's disease often uses time-consuming clinical evaluations and subjective assessments. Electrochemical Impedance Spectroscopy (EIS) is a useful technique for electroanalytical devices due to its label-free performance, in-situ measurements, and low cost. The development of reliable diagnostic tools for Parkinson's disease can be significantly enhanced by exploring novel techniques like faradaic and non-faradaic EIS detection methods. These techniques have the ability to identify specific biomarkers or changes in electrochemical properties linked to Parkinson's disease, allowing for an early and accurate diagnosis. Faradaic EIS detection methods utilize redox processes on the electrode surface, while non-faradaic EIS methods rely on charge transfer or capacitive properties. EIS can identify biomarkers or changes in electrical properties as indicators of Parkinson's disease by measuring impedance at different frequencies. By combining both faradaic and non-faradaic EIS approaches, it may be possible to obtain a comprehensive understanding of the electrochemical changes occurring in Parkinson's disease patients. This may lead to the development of more effective diagnostic techniques and potentially opening up new avenues for personalized treatment strategies. This review explores the current research on faradaic and non-faradaic EIS approaches for diagnosing Parkinson's disease using electrochemical impedance spectroscopy.
  13. Mapping of the Interaction Between Agrobacterium tumefaciens and Vanda Kasem's Delight Orchid Protocorm-Like Bodies
    Gnasekaran P, Subramaniam S
    Indian J Microbiol, 2015 Sep;55(3):285-91.
    PMID: 26063938 DOI: 10.1007/s12088-015-0519-7
    Physical contact between A. tumefaciens and the target plant cell walls is essential to transfer and integrate the transgene to introduce a novel trait. Chemotaxis response and attachment of Agrobacterium towards Vanda Kasem's Delight (VKD) protocorm-like bodies (PLBs) were studied to analyse the interaction between Agrobacterium and PLB during the transformation event. The study shows that initially A. tumefaciens reversibly attached to PLB surface via polar and lateral mode of adherence followed by the irreversible attachment which involved the production of cellulosic fibril by A. tumefaciens. Cellulosic fibril allows formation of biofilm at the tip of trichome. Contrarily, attachment mutant Escherichia coli strain DH5α was significantly deficient in the attachment process. Spectrophotometric GUS assay showed the mean value of attachment by A. tumefaciens was 8.72 % compared to the negative control E. coli strain DH5α that produced 0.16 %. A. tumefaciens swarmed with sharper and brighter edge when severe wounding was applied to the PLBs producing the highest swarming ratio of 1.46 demonstrating the positive effect of the plant exudates on bacterial movement. The study shows that VKD's PLBs are the suitable explants for Agrobacterium-mediated transformation since the bacteria expressed higher competency rate.
  14. Case Report: Metastatic Neck Nodes of Unknown Origin with Concurrent Tuberculous Lymphadenitis. Is Fine Needle Aspiration and Cytology (FNAC) Adequate?
    Subramaniam SD, Tuang GJ, Zainal Abidin ZA, Abdullah S
    Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):5888-5892.
    PMID: 36742794 DOI: 10.1007/s12070-021-02497-w
    Presentation with cervical lymphadenopathy would usually have an aetiology of neoplasm, infection or reactive cause. Dual pathology of regional metastasis with simultaneous occurrence of tuberculous lymphadenopathy is rather rare. Herein the authors present a case of primary occult carcinoma and tuberculous lymphadenopathy in an unfortunate patient. The reliability of fine-needle aspiration cytology as a first-line investigation, with alternative methods in approaching cervical lymphadenopathy, was further dissected.
  15. Fulltext Cytomegalovirus retinitis associated with high CD4 counts and DHEA abuse
    Keat GY, Ahmad SS, Subramaniam S, Ghani SA, Samsudin A
    Indian J Sex Transm Dis AIDS, 2020 06 18;41(1):119-122.
    PMID: 33062999 DOI: 10.4103/ijstd.IJSTD_90_15
    The most frequent ocular manifestation of acquired immunodeficiency syndrome (AIDS) is cytomegalovirus retinitis (CMVR). This infection is reportedly inversely proportional to the CD4 counts. Usually CMVR develops once the CD4 counts fall below 50/mm3. Our case report documents an AIDS patient who developed CMVR despite CD4 counts being persistently >200/mm3. The patient was self-administering dehydroepiandrosterone, high dose Vitamin C, testosterone and hydrocortisone. This case report describes a unique case of pharmacologically induced elevated CD4 counts, which however, did not prevent the development of CMVR in the patient.
  16. Hydrothermal synthesis of phosphorylated chitosan and its adsorption performance towards Acid Red 88 dye
    Subramaniam S, Foo KY, Md Yusof EN, Jawad AH, Wilson LD, Sabar S
    Int J Biol Macromol, 2021 Dec 15;193(Pt B):1716-1726.
    PMID: 34742842 DOI: 10.1016/j.ijbiomac.2021.11.009
    Phosphorylated chitosan (P-CS) was successfully synthesized using a facile experimental setup of hydrothermal method that was applied to the adsorption of anionic Acid Red 88 (AR88) from aqueous media. The adsorption process obeyed the pseudo-second-order (PSO) kinetic model. In contrast, the adsorption isotherm conformed to the Langmuir model, with the maximum adsorption capacity (qm = 230 mg g-1) at 303 K. Both external and intraparticle diffusion strongly influenced the rate of adsorption. The insights from this study reveal that P-CS could be easily prepared and regenerated for reusability applications. The adsorption mechanism and intermolecular interaction between P-CS and AR 88 were investigated using Fourier transform infrared (FTIR) spectroscopy and calculations via Density Functional Theory (DFT). The key modes of adsorption for the P-CS/AR 88 system are driven by electrostatic attractions, H-bonding, and n-π interactions. The findings herein reveal that P-CS is a promising adsorbent for the removal of anionic dyes such as AR88 or similar pollutants from water.
  17. Potentially inappropriate prescribing in a falls clinic using the STOPP and START criteria
    Chiam R, Saedon N, Khor HM, A/P Subramaniam S, Binti Mohmad Nasir SS, Binti Abu Hashim NFI, et al.
    Int J Clin Pharm, 2021 Oct 09.
    PMID: 34626298 DOI: 10.1007/s11096-021-01329-9
    Background Potentially inappropriate prescribing is increasingly common in older patients with falls. However, published indicators to assess inappropriate prescribing remains unestablished in many countries. Objective This study determined the burden and profile of potentially inappropriate prescribing among patients attending a falls clinic using the STOPP/START criteria and evaluated the factors for falls potentially associated to inappropriate prescribing. Setting University of Malaya Medical Centre Falls Clinic. Method Data of individuals aged ≥ 65 years referred to the falls and syncope clinic were extracted from the falls registry. Potentially inappropriate prescribing was determined with the STOPP/START version 2 criteria. The relationship between potentially inappropriate prescribing with polypharmacy (≥ 5 medications), comorbidities and clinical variables were determined using Pearson's chi-square and potential confounders adjusted for with multivariate regression. Main outcome measure Potentially inappropriate medicines and/or omitted medicines using STOPP/START criteria. Results Data from 421 individuals, aged 77.8 ± 6.7 years and 53.4% women, were included. Potentially inappropriate prescribing was present in 311 (73.9%). Potentially inappropriate medicines use accounted for 84.6% of the 325 prescriptions. 361/659 instances (54.8%) were falls-risk-increasing drugs, with vasodilators (49.3%) being the main potentially inappropriate medicine identified. Of the 177/421 with polypharmacy, 169/177 (95.5%) were exposed to ≥ one potentially inappropriate medicine. 129 instances of potentially omitted medicines were observed in 109 prescriptions (25.9%). Conclusion STOPP/START criteria are useful to identify potentially inappropriate prescribing at the falls and syncope clinic. This finding has important implications for medication review strategies at falls clinic. Future research should determine whether identifying potentially inappropriate prescribing may reduce adverse falls outcomes among patients in this setting.
  18. Fulltext Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country
    Kong YC, Bhoo-Pathy N, Subramaniam S, Bhoo-Pathy N, Taib NA, Jamaris S, et al.
    Int J Environ Res Public Health, 2017 04 16;14(4).
    PMID: 28420149 DOI: 10.3390/ijerph14040427
    Background: Survival disparities in cancer are known to occur between public and private hospitals. We compared breast cancer presentation, treatment and survival between a public academic hospital and a private hospital in a middle-income country. Methods: The demographics, clinical characteristics, treatment and overall survival (OS) of 2767 patients with invasive breast carcinoma diagnosed between 2001 and 2011 in the public hospital were compared with 1199 patients from the private hospital. Results: Compared to patients in the private hospital, patients from the public hospital were older at presentation, and had more advanced cancer stages. They were also more likely to receive mastectomy and chemotherapy but less radiotherapy. The five-year OS in public patients was significantly lower than in private patients (71.6% vs. 86.8%). This difference was largely attributed to discrepancies in stage at diagnosis and, although to a much smaller extent, to demographic differences and treatment disparities. Even following adjustment for these factors, patients in the public hospital remained at increased risk of mortality compared to their counterparts in the private hospital (Hazard Ratio: 1.59; 95% Confidence Interval: 1.36-1.85). Conclusion: Late stage at diagnosis appears to be a major contributing factor explaining the breast cancer survival disparity between public and private patients in this middle-income setting.
  19. Fulltext Behavioral theory-based framework for prediabetes self-care system-design perspectives and validation results
    Subramaniam S, Dhillon JS, Wan Ahmad WF
    Int J Environ Res Public Health, 2021 08 31;18(17).
    PMID: 34501750 DOI: 10.3390/ijerph18179160
    Type 2 diabetes (T2D) is a chronic condition that can lead to many life-threatening diseases. Prediabetes is defined as a state in which blood glucose levels are elevated but not high enough to be diagnosed as diabetes. This stage can be reversible with appropriate lifestyle and dietary modifications. Existing solutions are mostly developed to deal with T2D instead of preventing it in the first place. In this study, we propose a framework to aid in the development of self-care systems to prevent T2D, which integrates behavioral change theories and techniques and offers features, such as goal setting, activity planning, and health monitoring. We then assessed the feasibility of a prediabetes self-care system designed based on the proposed framework. Quantitative and qualitative methods were adopted in evaluating i-PreventDiabetes, a prototype. Numerous aspects of the prototype were evaluated, including (1) its effectiveness in assisting individuals with prediabetes in improving their health management behaviors, (2) its effect on users' attitudes toward diabetes prevention, (3) users' motivation levels, (4) user acceptability of the system, and (5) user experience. Users viewed i-PreventDiabetes positively and experienced a positive change in their attitude toward their health. Diabetes prevention systems, such as i-PreventDiabetes, have the potential to increase self-care behaviors among individuals with prediabetes, enabling them to manage their lifestyle and nutrition more effectively to avert a variety of potentially fatal conditions.
  20. Fulltext Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea-Experience from Three Southeast Asian Countries
    Zahedi FD, Subramaniam S, Kasemsiri P, Periasamy C, Abdullah B
    Int J Environ Res Public Health, 2022 Oct 25;19(21).
    PMID: 36360727 DOI: 10.3390/ijerph192113847
    BACKGROUND: Cerebrospinal fluid (CSF) rhinorrhea requires proper management to avoid disastrous consequences. The objectives of this study were to ascertain the patient characteristics, etiologies, sites of defect, skull base configurations, methods of investigation, and management outcomes of CSF rhinorrhea.

    METHODS: A retrospective study was performed over 4 years involving three surgeons from Malaysia, Singapore, and Thailand. Hospital records were reviewed to determine the patients' characteristics, the causes and sites of leaks, methods of investigation, skull base configurations, choices of treatment, and outcomes.

    RESULTS: A total of 15 cases (7 traumatic and 8 non-traumatic) were included. Imaging was performed in all cases. The most common site of leakage was the cribriform plate (9/15 cases). The mean ± SD of the Keros heights were 4.43 ± 1.66 (right) and 4.21 ± 1.76 mm (left). Type II Keros was the most common (60%). The mean ± SD angles of the cribriform plate slope were 51.91 ± 13.43 degrees (right) and 63.54 ± 12.64 degrees (left). A class II Gera configuration was the most common (80%). All except two patients were treated with endonasal endoscopic surgical repair, with a success rate of 92.3%. A multilayered repair technique was used in all patients except one. The mean ± SD postoperative hospital stay was 9.07 ± 6.17 days.

    CONCLUSIONS: Non-traumatic CSF rhinorrhea outnumbered traumatic CSF rhinorrhea, with the most common site of leak at the cribriform plate. Imaging plays an important role in investigation, and Gera classification appears to be better than Keros classification for evaluating risk. Both conservative and surgical repairs are practiced with successful outcomes. Endonasal endoscopic CSF leak repair is the mainstay treatment.

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