Displaying publications 41 - 60 of 134 in total

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  1. Mohd Basri MS, Liew Min Ren B, A Talib R, Zakaria R, Kamarudin SH
    Polymers (Basel), 2021 May 14;13(10).
    PMID: 34069259 DOI: 10.3390/polym13101581
    Dry mangosteen leaves are one of the raw materials used to produce marker ink. However, research using this free and abundant resource is rather limited. The less efficient one-factor-at-a-time (OFAT) approach was mostly used in past studies on plant-based marker ink. The use of statistical analysis and the regression coefficient model (mathematical model) was considered essential in predicting the best combination of factors in formulating mangosteen leaf-based marker ink. Ideally, ink should have maximum color lightness, minimum viscosity, and fast-drying speed. The objective of this study to study the effect of glycerol and carboxymethyl cellulose (CMC) on the color lightness and viscosity of mangosteen-leaves-based marker ink. The viscosity, color lightness, and drying properties of the ink were tested, the significant effect of glycerol and CMC (responses) on ink properties was identified and the prediction model on the optimum value of the responses was developed by using response surface methodology (RSM). The microstructure of mangosteen leaves was analyzed to study the surface morphology and cell structure during dye extraction. A low amount of glycerol used was found to increase the value of color lightness. A decrease in CMC amounts resulted in low viscosity of marker ink. The optimum formulation for the ink can be achieved when the weight percents of glycerol, benzalkonium chloride, ferrous sulphate, and CMC are set at 5, 5, 1, and 3, respectively. SEM micrographs showed the greatest amount of cell wall structure collapse on samples boiled with the lowest amount of glycerol.
  2. Mahmud KA, Zakaria R, Azman M, Mat Baki M
    ORL J Otorhinolaryngol Relat Spec, 2021 05 05;83(4):295-298.
    PMID: 33951656 DOI: 10.1159/000515424
    Adult laryngeal haemangioma is normally seen in the supraglottic or glottic region. Transglottic haemangioma is unusual, and treatment with primary endolaryngeal surgical excision may lead to undesirable bleeding and poor voice outcomes. A 25-year-old female presented with hoarseness and progressive upper airway obstruction symptoms. Videoendoscopy showed haemangioma involving all unilateral subunits of the larynx obstructing half of the subglottis. The transglottic haemangioma was treated with endolaryngeal ethanol injection with prior tracheostomy under local anaesthesia. Endolaryngeal laser surgery was performed later on to remove small residual haemangioma and granuloma. The haemangioma resolved; however, the ethanol injection to the paraglottic space results in vocal fold immobility but with favourable position and good muscle tone and bulk. The patient was successfully decannulated. Post-intervention subjective and objective voice assessments showed normal parameters except slight impairment of voice handicap index-10 with a total score of 12. Adult transglottic haemangioma can cause upper airway obstruction and requires intervention. Excision of the lesion endoscopically without sacrificing voice is achievable.
  3. Ya SNC, Muhamad R, Zakaria R, Ishak A, Abdullah WNHW
    Korean J Fam Med, 2021 May;42(3):245-249.
    PMID: 31968408 DOI: 10.4082/kjfm.19.0068
    Lucio phenomenon is a potentially fatal leprosy reaction seen in pure, primitive, and diffuse form of lepromatous leprosy. It is a globally restricted phenomenon that occurs in Mexico and Costa Rica; however, sporadic cases have been reported elsewhere. We report a rare case of a 50-year-old Indonesian, who resided in Malaysia for the past 33 years, which presented with extensive ulcers on all four limbs for 3 weeks, as well as a 16-year history of skin changes and alopecia. Full evaluation established the diagnosis of lepromatous leprosy with Lucio phenomenon. Delay in diagnosis leads to significant disabilities and disease transmission within the community. Therefore, primary care practitioners, even in non-endemic countries, should be wary of this atypical feature of leprosy to prevent complications since it is a highly curable disease.
  4. Abdo Qaid EY, Zulkipli NN, Zakaria R, Ahmad AH, Othman Z, Muthuraju S, et al.
    Int J Neurosci, 2021 May;131(5):482-488.
    PMID: 32202188 DOI: 10.1080/00207454.2020.1746308
    Hypoxia has been associated with cognitive impairment. Many studies have investigated the role of mTOR signalling pathway in cognitive functions but its role in hypoxia-induced cognitive impairment remains controversial. This review aimed to elucidate the role of mTOR in the mechanisms of cognitive impairment that may pave the way towards the mechanistic understanding and therapeutic intervention of hypoxia-induced cognitive impairment. mTORC1 is normally regulated during mild or acute hypoxic exposure giving rise to neuroprotection, whereas it is overactivated during severe or chronic hypoxia giving rise to neuronal cells death. Thus, it is worth exploring the possibility of maintaining normal mTORC1 activity and thereby preventing cognitive impairment during severe or chronic hypoxia.
  5. Safdar A, Azman KF, Zakaria R, Ab Aziz CB, Rashid U
    J Tradit Complement Med, 2021 Mar;11(2):117-122.
    PMID: 33728271 DOI: 10.1016/j.jtcme.2020.02.005
    Background and aim: Goat milk is a food of high nutritional value and has been proved to possess strong antioxidant and anti-inflammatory properties. However, thus far, little is known of its possible effects on brain especially on memory during aging. The aim of this study was to assess the effect of goat milk supplementation on memory in d-galactose-induced aging rat model.

    Experimental procedure: Fifty-two male Sprague Dawley rats were randomly divided into four groups: 1) control group, 2) goat milk treated group, 3) d-galactose treated group, and 4) goat milk plus d-galactose treated group. Goat milk (1 g/kg orally) and/or d-galactose (120 mg/kg subcutaneously) were administered continuously for six weeks preceded and followed by novel object recognition and T-maze test.

    Results and conclusion: Prior to goat milk and d-galactose administration, there was no significant difference (p > 0.05) in memory between all groups. Goat milk administration alone significantly increased short- and long-term memory (p 

  6. Voon NS, Lau FN, Zakaria R, Md Rani SA, Ismail F, Manan HA, et al.
    Cancer Radiother, 2021 Feb;25(1):62-71.
    PMID: 33414057 DOI: 10.1016/j.canrad.2020.07.008
    PURPOSE: Nasopharyngeal carcinoma (NPC) radiotherapy (RT) irradiates parts of the brain which may cause cerebral tissue changes. This study aimed to systematically review the brain microstructure changes using MRI-based measures, diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI) and voxel-based morphometry (VBM) and the impact of dose and latency following RT.

    METHODS: PubMed and Scopus databases were searched based on PRISMA guideline to determine studies focusing on changes following NPC RT.

    RESULTS: Eleven studies fulfilled the inclusion criteria. Microstructural changes occur most consistently in the temporal region. The changes were correlated with latency in seven studies; fractional anisotropy (FA) and gray matter (GM) volume remained low even after a longer period following RT and areas beyond irradiation site with reduced FA and GM measures. For dosage, only one study showed correlation, thus requiring further investigations.

    CONCLUSION: DTI, DKI and VBM may be used as a surveillance tool in detecting brain microstructural changes of NPC patients which correlates to latency and brain areas following RT.

  7. Zakaria R, Ahmi A, Ahmad AH, Othman Z
    Chronobiol Int, 2021 01;38(1):27-37.
    PMID: 33164592 DOI: 10.1080/07420528.2020.1838534
    This study presents a bibliometric analysis of the publications on melatonin research from the Scopus database during the period 2015-2019. Based on the keywords used, which are related to melatonin in the article title, the study retrieved 4411 documents for further analysis using various tools. We used Microsoft Excel to conduct the frequency analysis, VOSviewer for data visualization, and Harzing's Publish or Perish for citation metrics and analysis. This study reports the results using standard bibliometric indicators such as the growth of publications, authorship patterns, collaboration, and prolific authors, country contribution, most active institutions, preferred journals, and top-cited articles. Based on our findings, there is a continuous growth of publications on melatonin research for 5 years since 2015. China was the largest contributor to melatonin research, followed by the United States. The Journal of Pineal Research published the most number of publications related to melatonin research. Our findings suggest that the role of melatonin in plant and food sciences, as well as in cancer, may in later years take over the clusters that earlier dominated melatonin research.
  8. Abd Aziz CB, Hasim H, Zakaria R, Ahmad AH
    Turk J Pharm Sci, 2020 Dec 23;17(6):620-625.
    PMID: 33389951 DOI: 10.4274/tjps.galenos.2019.21548
    Objectives: This study investigated whether the alterations in memory and hippocampus morphology and levels of malondialdehyde (MDA) and N-methyl-D-aspartate (NMDA) receptor in the hippocampus of adult rats after prenatal stress could be prevented by administration of Tualang honey (TH).

    Materials and Methods: Twenty-four pregnant rats were randomly grouped into a control group (C), a stress group (S), and a stress group treated with TH. Eight male pups from each group were randomly chosen and they were sacrificed at eight or ten weeks of age following the novel object recognition test. Their brains were removed and histological changes and levels of MDA and NMDA receptors in the hippocampus were determined.

    Results: The offspring from TH group showed significantly increased preference index (p<0.05) with higher neuronal number compared to S group. A significantly lower level of MDA and NMDA receptors were shown in TH group (P<0.01; P<0.05 respectively) compared to S group. The parameters investigated were not significantly different between C and TH groups.

    Conclusion: The study has shown that memory alteration, changes in hippocampus histology, MDA and NMDA receptor levels could be prevented by TH administration during prenatal stress. The results suggest the beneficial effects of Tualang honey in prenatally stressed rat offspring.

  9. Idris NA, Zakaria R, Muhamad R, Nik Husain NR, Ishak A, Wan Mohammad WMZ
    Malays J Med Sci, 2020 Dec;27(6):102-114.
    PMID: 33447138 DOI: 10.21315/mjms2020.27.6.10
    Background: Tuberculosis (TB) is contagious and the transmission risk is high in congregate settings like school. Incidence of TB among adolescents is significantly high hence an education programme was developed to improve knowledge, attitude, practice and stigma (KAPS) among them.

    Methods: This school-based, non-randomised controlled study was conducted among secondary school students with a total of 236 respondents. The KAPS score were assessed before and 1 month after using self-administered validated KAPS questionnaire on TB. Analysis was done using repeated measures ANOVA.

    Results: The mean percentage score (SD) for baseline knowledge, attitude, practice and stigma score for the respondents were 54.0 (4.48), 65.6 (1.74), 70.0 (1.43) and 66.0 (6.88), respectively. There was a significant difference (P < 0.001) in the knowledge and stigma score for intervention group compared to control group, adjusted for gender, ethnicity and smoking status 4 weeks post-TB educational programme. However, with regards to attitude and practice score, there was no significant difference (P = 0.210 and P = 0.243, respectively).

    Conclusion: TB education programme was effective in improving knowledge and stigma related to TB. This health education programme can be used as one of the strategies for the prevention and control of TB in schools.

  10. Sajid MR, Muhammad N, Zakaria R, Bukhari SAC
    J Public Health Res, 2020 Oct 14;9(4):1893.
    PMID: 33244464 DOI: 10.4081/jphr.2020.1893
    Background: Modifiable risk factors are associated with cardiovascular mortality (CVM) which is a leading form of global mortality. However, diverse nature of urbanization and its objective measurement can modify their relationship. This study aims to investigate the moderating role of urbanization in the relationship of combined exposure (CE) of modifiable risk factors and CVM. Design and Methods: This is the first comprehensive study which considers different forms of urbanization to gauge its manifold impact. Therefore, in addition to existing original quantitative form and traditional two categories of urbanization, a new form consisted of four levels of urbanization was duly introduced. This study used data of 129 countries mainly retrieved from a WHO report, Non-Communicable Diseases Country Profile 2014. Factor scores obtained through confirmatory factor analysis were used to compute the CE. Age-income adjusted regression model for CVM was tested as a baseline with three bootstrap regression models developed for the three forms of urbanization. Results: Results revealed that the CE and CVM baseline relationship was significantly moderated through the original quantitative form of urbanization. Contrarily, the two traditional categories of urbanization could not capture the moderating impact. However, the four levels of urbanization were objectively estimated the urbanization impact and subsequently indicated that the CE was more alarming in causing the CVM in levels 2 and 3 urbanized countries, mainly from low-middle-income countries. Conclusion: This study concluded that the urbanization is a strong moderator and it could be gauged effectively through four levels whereas sufficiency of two traditional categories of urbanization is questionable.
  11. Qaid EYA, Zakaria R, Mohd Yusof NA, Sulaiman SF, Shafin N, Othman Z, et al.
    Turk J Pharm Sci, 2020 Oct;17(5):555-564.
    PMID: 33177938 DOI: 10.4274/tjps.galenos.2019.32704
    Objectives: A growing body of evidence indicates that hypoxia exposure causes learning and memory deficits. An effective natural therapeutic approach has, however, not been explored widely. Our previous studies found that Tualang honey administration protected learning and memory functions in ovariectomized rats. Therefore, the present study investigated its efficacy in ameliorating hypoxia-induced memory deficits in adult male Sprague Dawley rats.

    Materials and Methods: The rats were divided into four groups: i) Normoxia treated with sucrose (n=12), ii) Normoxia treated with Tualang honey (n=12), iii) Hypoxia treated with sucrose (n=12), and iv) Hypoxia treated with Tualang honey (n=12). Tualang honey (0.2 g/kg/BW) and sucrose (1 mL of 7.9%) supplementations were administered orally to the rats daily for 14 days. Then the hypoxia groups were exposed to hypoxia (~11%) for 7 days, while the normoxia groups were kept in normal conditions. Following exposure to hypoxia, the rats' memories were analyzed using a novel object recognition task and T-maze test.

    Results: The data revealed that rats exposed to hypoxia showed significant impairment in short-term memory (STM), spatial memory (p<0.01), and long-term memory (LTM) when compared to the normoxia group. Hypoxia rats treated with Tualang honey showed significant improvement in STM, LTM, and spatial memory (p<0.05) compared with those treated with sucrose (p<0.05). Tualang honey also reduced neuronal damage in the hippocampus of adult male Sprague Dawley rats exposed to hypoxia.

    Conclusion: It is suggested that Tualang honey pretreatment has protective effects against hypoxia-induced memory deficits, possibly through its antioxidant contents.

  12. Gagman HA, Him NAIIN, Ahmad H, Sulaiman SF, Zakaria R, Termizi FHM
    Trop Life Sci Res, 2020 Oct;31(3):145-159.
    PMID: 33214861 DOI: 10.21315/tlsr2020.31.3.10
    Gastrointestinal nematode infections can cause great losses in revenue due to decrease livestock production and animal death. The use of anthelmintic to control gastrointestinal nematode put a selection pressure on nematode populations which led to emergence of anthelmintic resistance. Because of that, this study was carried out to investigate the efficacy of aqueous and methanol extract of Cassia siamea against the motility of C. elegans Bristol N2 and C. elegans DA1316. Caenorhabditis elegans Bristol N2 is a susceptible strain and C. elegans DA1316 is an ivermectin resistant strain. In vitro bioassay of various concentrations of (0.2, 0.6, 0.8, 1.0 and 2.0 mg mL-1) aqueous and methanol extracts of C. siamea was conducted against the motility of L4 larvae of C. elegans Bristol N2 and C. elegans DA1316. The L4 larvae were treated with 0.02 μg mL-1 of ivermectin served as positive control while those in M9 solution served as negative control. The activity of the extracts was observed after 24 h and 48 h. A significant difference was recorded in the extract performance compared to control at (P < 0.001) after 48 h against the motility of the larvae of both strains. The methanol extracts inhibited the motility of C. elegans Bristol N2 by 86.7% as well as DA1316 up to 84.9% at 2.0 mg mL-1 after 48 h. The methanol extract was more efficient than aqueous extract (P < 0.05) against the motility of both strains of C. elegans. Cassia siamea may be used as a natural source of lead compounds for the development of alternative anthelmintic against parasitic nematodes as well ivermectin resistant strains of nematodes.
  13. Zulkipli NN, Zakaria R, Long I, Abdullah SF, Muhammad EF, Wahab HA, et al.
    Molecules, 2020 Sep 02;25(17).
    PMID: 32887218 DOI: 10.3390/molecules25173991
    Natural products remain a popular alternative treatment for many ailments in various countries. This study aimed to screen for potential mammalian target of rapamycin (mTOR) inhibitors from Malaysian natural substance, using the Natural Product Discovery database, and to determine the IC50 of the selected mTOR inhibitors against UMB1949 cell line. The crystallographic structure of the molecular target (mTOR) was obtained from Protein Data Bank, with Protein Data Bank (PDB) ID: 4DRI. Everolimus, an mTOR inhibitor, was used as a standard compound for the comparative analysis. Computational docking approach was performed, using AutoDock Vina (screening) and AutoDock 4.2.6 (analysis). Based on our analysis, asiaticoside and its derivative, asiatic acid, both from Centella asiatica, revealed optimum-binding affinities with mTOR that were comparable to our standard compound. The effect of asiaticoside and asiatic acid on mTOR inhibition was validated with UMB1949 cell line, and their IC50 values were 300 and 60 µM, respectively, compared to everolimus (29.5 µM). Interestingly, this is the first study of asiaticoside and asiatic acid against tuberous sclerosis complex (TSC) disease model by targeting mTOR. These results, coupled with our in silico findings, should prompt further studies, to clarify the mode of action, safety, and efficacy of these compounds as mTOR inhibitors.
  14. Md Said R, Mohd Zain R, Chan HK, Soelar SA, Rusli N, Nasir NH, et al.
    J Viral Hepat, 2020 06;27(6):638-643.
    PMID: 31997563 DOI: 10.1111/jvh.13267
    Approximately 2.5% of the Malaysian population is currently living with hepatitis C virus (HCV) infection. Yet, the public awareness of the disease is limited and under-screening remains a major challenge. With the support of international non-for-profit organizations, the Ministry of Health in Malaysia recently launched a one-week nationwide hepatitis C screening campaign in conjunction with the World Hepatitis Day. For the first time, the rapid diagnostic test (RDT) for HCV screening was introduced in public health institutions. This campaign involved 49 hospitals and 38 health clinics across the country, targeting the adult general population with unknown HCV infection status. Of the 11 382 participants undergoing the RDT, 1.9% were found to be positive for hepatitis C antibody (anti-HCV) and were referred to on-site medical departments or nearby hospitals for confirmatory testing and treatment. Men, the Malay ethnic group, intranasal and injection drug users and ex-prisoners were shown to have higher odds of being positive for anti-HCV. In addition to serving as a model to educate the general population about the disease, this campaign demonstrates the feasibility of decentralizing HCV screening, particularly by promoting the use of RDT, and linking the HCV-infected patients to care in Malaysia.
  15. Khor SP, Yeow LC, Poobathy R, Zakaria R, Chew BL, Subramaniam S
    Biotechnol Rep (Amst), 2020 Jun;26:e00448.
    PMID: 32368510 DOI: 10.1016/j.btre.2020.e00448
    A droplet-vitrification cryopreservation protocol has been successfully developed for Aranda Broga Blue orchid hybrid using protocorm-like bodies (PLBs). However, maximum growth regeneration percentage was recorded at 5% only based on previous report. Thus, to improve growth recovery of cryopreserved PLBs, cryopreservation stages were supplemented with ascorbic acid, tested at 50, 100 and 150 mg/L. However, results demonstrated that exogenous ascorbic acid was not favorable in regeneration of cryopreserved explants (maximum value of 1.67 % with 50 mg/L ascorbic acid supplementation). Total soluble protein and various antioxidant enzyme activities such as catalase (CAT), superoxide dismutase (SOD) and ascorbate peroxidase (APX) were evaluated after each cryopreservation stages in conjunction with the application of exogenous ascorbic acid. Addition of antioxidant must be carefully evaluated and its application may not guarantee successful growth recovery. RAPD and SCoT molecular analysis confirmed the genetic stability of regenerated cryopreserved PLBs as no polymorphism was detected compared to control PLBs culture.
  16. Safdar A, Zakaria R, Aziz CBA, Rashid U, Azman KF
    Biogerontology, 2020 04;21(2):203-216.
    PMID: 31792648 DOI: 10.1007/s10522-019-09854-x
    One of the most significant hallmarks of aging is cognitive decline. D-galactose administration may impair memory and mimic the effects of natural aging. In this study, the efficiency of goat milk to protect against memory decline was tested. Fifty-two male Sprague-Dawley rats were randomly divided into four groups: (i) control group, (ii) goat milk treated group, (iii) D-galactose treated group, and (iv) goat milk plus D-galactose treated group. Subcutaneous injections of D-galactose at 120 mg/kg and oral administrations of goat milk at 1 g/kg were chosen for the study. Goat milk and D-galactose were administered concomitantly for 6 weeks, while the control group received saline. After 6 weeks, novel object recognition and T-maze tests were performed to evaluate memory of rats. Following behavioral tests, the animals were sacrificed, and right brain homogenates were analyzed for levels of lipid peroxidation, antioxidant enzymes and neurotrophic factors. The left brain hemisphere was used for histological study of prefrontal cortex and hippocampus. There was a significant memory impairment, an increase in oxidative stress and neurodegeneration and a reduction in antioxidant enzymes and neurotrophic factors levels in the brain of D-galactose treated rats compared to controls. Goat milk treatment attenuated memory impairment induced by D-galactose via suppressing oxidative stress and neuronal damage and increasing neurotrophic factors levels, thereby suggesting its potential role as a geroprotective food.
  17. Sagadevan S, Venilla S, Marlinda AR, Johan MR, Wahab YA, Zakaria R, et al.
    J Nanosci Nanotechnol, 2020 Apr 01;20(4):2488-2494.
    PMID: 31492266 DOI: 10.1166/jnn.2020.17185
    Herein, we report the effect of synthesis temperature on the morphologies, optical and electronic properties of magnesium oxide (MgO) nanostructures. The MgO nanostructures were synthesized at different temperatures, i.e., 100 °C, 300 °C, and 600 °C by simple chemical reaction process and their morphology, particle size, optical, and electrical properties were examined by different techniques such as scanning electron microscopy (SEM), X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy and UV-Vis. spectroscopy. The morphological investigations revealed that various morphologies of MgO nanostructures, i.e., nanoparticles, nanosheet networks, and nanoneedles were synthesized at 100 °C, 300 °C, and 600 °C. The XRD results confirmed that with increasing the synthesis temperature, the crystallinity of the synthesized nanostructures increases. Further, the dielectric properties and AC conductivity at various frequencies for MgO nanostructures were studied which revealed that the dielectric losses decrease with increase in frequency and temperature. In addition, the observed band gap decreases from 4.89 eV to 4.438 eV (100 °C to 600 °C) representing its increase in the conductivity.
  18. Tan PC, Kartik B, Thanendran P, Zakaria R, Win ST, Omar SZ
    Sci Rep, 2020 03 10;10(1):4445.
    PMID: 32157169 DOI: 10.1038/s41598-020-61114-y
    A case-controlled study was performed to evaluate taste and smell impairment, nausea or vomiting (NV) response to taste and smell and toleration to food texture, item and cooking method in hyperemesis gravidarum patients (HG) compared to gestation-matched controls from a university hospital and primary care clinic in Malaysia. Taste strips (4 base tastes), sniff sticks (16 selected smells) and a food-related questionnaire were used. 124 participants were recruited. Taste impairment was found in 13%(8/62) vs. 0%(0/62) P = 0.003 and the median for correct smell identification was 5[4-6] vs. 9[7-9] P 
  19. Mat MAC, Yaacob LH, Zakaria R
    Malays J Med Sci, 2020 Feb;27(1):124-133.
    PMID: 32158352 MyJurnal DOI: 10.21315/mjms2020.27.1.13
    Introduction: Acceptance of a screening programme for thalassemia is important in managing the disease and its associated complications. The objective of this study was to determine the knowledge of thalassemia and factors associated with thalassemia screening refusal among parents of secondary school children.

    Methods: This cross-sectional study was carried out from May 2017 to October 2017 among parents of fourth form students in three schools in Besut, Terengganu, Malaysia. Parents who are able to read and understand Malay and consented to the study were required to answer a validated questionnaire on their knowledge regarding thalassemia. They were also asked the reason for their acceptance or refusal of the thalassemia screening of their children.

    Results: In total, 273 participants took part in the study. The mean thalassemia knowledge score was 11.8 out of a maximum score of 21. Low knowledge scores (adjusted odds ratio [adj OR] 0.87; 95% confidence interval [CI]: 0.79, 0.95; P = 0.002) and female sex (adj OR 2.60; 95% CI: 1.04, 6.53; P = 0.040) had significant associations with parental thalassemia screening refusal. The main reason for screening refusal was that parents perceived that their children were not at risk for the disease since they did not have a family member with thalassemia.

    Conclusion: The mean thalassemia knowledge score among parents remains unsatisfactory. A high knowledge score is important since it is associated with parental acceptance of thalassemia screening for their children.

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