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Fulltext Mobile Health Apps on COVID-19 Launched in the Early Days of the Pandemic: Content Analysis and Review

Ming LC, Untong N, Aliudin NA, Osili N, Kifli N, Tan CS, et al.

JMIR Mhealth Uhealth, 2020 09 16;8(9):e19796.
PMID: 32609622 DOI: 10.2196/19796

BACKGROUND: Mobile health (mHealth) app use is a major concern because of the possible dissemination of misinformation that could harm the users. Particularly, it can be difficult for health care professionals to recommend a suitable app for coronavirus disease (COVID-19) education and self-monitoring purposes.
OBJECTIVE: This study aims to analyze and evaluate the contents as well as features of COVID-19 mobile apps. The findings are instrumental in helping health care professionals to identify suitable mobile apps for COVID-19 self-monitoring and education. The results of the mobile apps' assessment could potentially help mobile app developers improve or modify their existing mobile app designs to achieve optimal outcomes.
METHODS: The search for the mHealth apps available in the android-based Play Store and the iOS-based App Store was conducted between April 18 and May 5, 2020. The region of the App Store where we performed the search was the United States, and a virtual private network app was used to locate and access COVID-19 mobile apps from all countries on the Google Play Store. The inclusion criteria were apps that are related to COVID-19 with no restriction in language type. The basic features assessment criteria used for comparison were the requirement for free subscription, internet connection, education or advisory content, size of the app, ability to export data, and automated data entry. The functionality of the apps was assessed according to knowledge (information on COVID-19), tracing or mapping of COVID-19 cases, home monitoring surveillance, online consultation with a health authority, and official apps run by health authorities.
RESULTS: Of the 223 COVID-19-related mobile apps, only 30 (19.9%) found in the App Store and 28 (44.4%) in the Play Store matched the inclusion criteria. In the basic features assessment, most App Store (10/30, 33.3%) and Play Store (10/28, 35.7%) apps scored 4 out of 7 points. Meanwhile, the outcome of the functionality assessment for most App Store apps (13/30, 43.3%) was a score of 3 compared to android-based apps (10/28, 35.7%), which scored 2 (out of the maximum 5 points). Evaluation of the basic functions showed that 75.0% (n=36) of the 48 included mobile apps do not require a subscription, 56.3% (n=27) provide symptom advice, and 41.7% (n=20) have educational content. In terms of the specific functions, more than half of the included mobile apps are official mobile apps maintained by a health authority for COVID-19 information provision. Around 37.5% (n=18) and 31.3% (n=15) of the mobile apps have tracing or mapping and home monitoring surveillance functions, respectively, with only 17% (n=8) of the mobile apps equipped with an online consultation function.
CONCLUSIONS: Most iOS-based apps incorporate infographic mapping of COVID-19 cases, while most android-based apps incorporate home monitoring surveillance features instead of providing focused educational content on COVID-19. It is important to evaluate the contents and features of COVID-19 mobile apps to guide users in choosing a suitable mobile app based on their requirements.
Prolonged high biomass diatom blooms induced formation of hypoxic-anoxic zones in the inner part of Johor Strait

Mohd-Din M, Abdul-Wahab MF, Mohamad SE, Jamaluddin H, Shahir S, Ibrahim Z, et al.

Environ Sci Pollut Res Int, 2020 Dec;27(34):42948-42959.
PMID: 32725555 DOI: 10.1007/s11356-020-10184-6

The Johor Strait has experienced rapid development of various human activities and served as the main marine aquaculture area for the two countries that bordered the strait. Several fish kill incidents in 2014 and 2015 have been confirmed, attributed to the algal blooms of ichthyotoxic dinoflagellates; however, the cause of fish kill events after 2016 was not clarified and the causative organisms remained unknown. To clarify the potential cause of fish kills along the Johor Strait, a 1-year field investigation was conducted with monthly sampling between May 2018 and April 2019. Monthly vertical profiles of physical water parameters (temperature, salinity, and dissolved oxygen levels) were measured in situ at different depths (subsurface, 1 m, 5 m, and 8 m) depending on the ambient depth of the water column at the sampling stations. The spatial-temporal variability of macronutrients and chlorophyll a content was analyzed. Our results showed that high chlorophyll a concentration (up to 48.8 μg/L) and high biomass blooms of Skeletonema, Chaetoceros, Rhizosolenia, and Thalassiosira were observed seasonally at the inner part of the strait. A hypoxic to anoxic dead zone, with the dissolved oxygen levels ranging from 0.19 to 1.7 mg/L, was identified in the inner Johor Strait, covering an estimated area of 10.3 km2. The occurrence of high biomass diatom blooms and formation of the hypoxic-anoxic zone along the inner part Johor Strait were likely the culprits of some fish kill incidents after 2016.
Human Immunodeficiency Virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia

Ong SY, Tang MM, Dalawi I, Tan WC, Yeoh CA, Kho WM, et al.

Med J Malaysia, 2020 07;75(4):349-355.
PMID: 32723993

OBJECTIVES: High rates of syphilis have been reported worldwide among men who have sex with men (MSM). This study aims to describe the clinical pattern and treatment response of syphilis among human immunodeficiency virus (HIV)-infected MSM in Malaysia.
METHODS: This is a retrospective study on all HIV-infected MSM with syphilis between 2011 and 2015. Data was collected from case notes in five centres namely Hospital Kuala Lumpur, Hospital Sultanah Bahiyah, Hospital Umum Sarawak, University of Malaya Medical Centre and Hospital Sungai Buloh.
RESULTS: A total of 294 HIV seropositive MSM with the median age of 29 years (range 16-66) were confirmed to have syphilis. Nearly half (47.6%) were in the age group of 20-29 years. About a quarter (24.1%) was previously infected with syphilis. Eighty-three patients (28.2%) had other concomitant sexually transmitted infection with genital warts being the most frequently reported (17%). The number of patients with early and late syphilis in our cohort were almost equal. The median pre-treatment non-treponemal antibody titre (VDRL or RPR) for early syphilis (1:64) was significantly higher than for late syphilis (1:8) (p<0.0001). The median CD4 count and the number of patients with CD4 <200/μl in early syphilis were comparable to late syphilis. Nearly four-fifth (78.9%) received benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of the above medications. About 44% received treatment and were lost to follow-up. Among those who completed 1 -year follow-up after treatment, 72.3% responded to treatment (serological non-reactive - 18.2%, four-fold drop in titre - 10.9%; serofast - 43.6%), 8.5% failed treatment and 17% had re-infection. Excluding those who were re-infected, lost to follow-up and died, the rates of treatment failure were 12.1% and 8.8% for early and late syphilis respectively (p=0.582).
CONCLUSION: The most common stage of syphilis among MSM with HIV was latent syphilis. Overall, about 8.5% failed treatment at 1-year follow-up.
Fulltext Knowledge, attitude and practice on dengue prevention and dengue seroprevalence in a dengue hotspot in Malaysia: A cross-sectional study

Selvarajoo S, Liew JWK, Tan W, Lim XY, Refai WF, Zaki RA, et al.

Sci Rep, 2020 Jun 12;10(1):9534.
PMID: 32533017 DOI: 10.1038/s41598-020-66212-5

Dengue has become a global public health problem. Despite reactive efforts by the government in Malaysia, the dengue cases are on the increase. Adequate knowledge, positive attitude and correct practice for dengue control are essential to stamp out the disease. Hence, this study aims to assess the factors associated with dengue knowledge, attitude and practice (KAP), as well as the association with dengue IgM and IgG seropositivity. A community-based cross-sectional study was conducted in a closed, dengue endemic area with multi-storey dwellings . Five hundred individuals (aged 18 years and above) were approached for pre-tested KAP and seroprevalences assessment. The study showed only half of the total participants have good knowledge (50.7%) but they had insufficient knowledge about dengue during pregnancy. 53.2% of people had poor attitude and 50.2% reported poor practice for dengue control. Out of 85 respondents who agreed to participate in the dengue seroprevalence study, 74.1% (n = 63) were positive for dengue IgG and 7.1% (n = 6) were positive for dengue IgM. Among all sociodemographic variable, race is the only independent predicator for all KAP levels (P
Phomopsidione-Loaded Chitosan Polyethylene Glycol (PEG) Nanocomposite Dressing for Pressure Ulcers

Chin IBI, Yenn TW, Ring LC, Lazim Y, Tan WN, Rashid SA, et al.

J Pharm Sci, 2020 09;109(9):2884-2890.
PMID: 32534882 DOI: 10.1016/j.xphs.2020.06.005

Pressure ulcers are commonly associated with microbial infections on the wounds which require an effective wound dressing for treatment. Thus far, the available silver dressing has shown tremendous result, however, it may cause argyria and complicate the internal organ function. Hence, our study aims to develop and characterize phomopsidione-loaded chitosan-polyethylene glycol nanocomposite hydrogel (C/PEG/Ph) as an antimicrobial dressing. Physically, the C/PEG/Ph hydrogel demonstrated a uniform light blue color, soft, flexible, and elastic, with no aggregation form. The evaluation via Fourier Transform Infrared (FTIR) exposed the C/PEG/Ph hydrogel has a notable shift towards lower frequency at 1600 and 1554 cm-1. For drug release test, the phomopsidione attained plateau at 24 h, with a total release of 67.9 ± 6.4% from the C/PEG/Ph hydrogel. There was a null burst release effect discovered throughout the experimental period. The C/PEG/Ph hydrogel showed significant results against all 4 Gram-negative bacteria and 1 yeast, with 99.99-100% reduction of microbial growth. The findings revealed that the C/PEG/Ph hydrogel can potentially act as an antimicrobial dressing for pressure ulcers.
Fulltext Clinical Phenotype of LRRK2 R1441C in 2 Chinese Sisters

Lim SY, Lim JL, Ahmad-Annuar A, Lohmann K, Tan AH, Lim KB, et al.

Neurodegener Dis, 2020;20(1):39-45.
PMID: 32580205 DOI: 10.1159/000508131

Pathogenic and risk variants in the LRRK2 gene are among the main genetic contributors to Parkinson's disease (PD) worldwide, and LRRK2-targeted therapies for patients with PARK-LRRK2are now entering clinical trials. However, in contrast to the LRRK2 G2019S mutation commonly found in Caucasians, North-African Arabs, and Ashkenazi Jews, relatively little is known about other causative LRRK2 mutations, and data on genotype-phenotype correlations are largely lacking. This report is from an ongoing multicentre study in which next-generation sequencing-based PD gene panel testing has so far been conducted on 499 PD patients of various ethnicities from Malaysia. We describe 2 sisters of Chinese ancestry with PD who carry the R1441C mutation in LRRK2 (which in Asians has been reported in only 2 Chinese patients previously), and highlight interesting clinical observations made over a decade of close follow-up. We further explored the feasibility of using a brief, expert-administered rating scale (the Clinical Impression of Severity Index; CISI-PD) to capture data on global disease severity in a large (n = 820) unselected cohort of PD patients, including severely disabled individuals typically excluded from research studies. All patients in this study were managed and evaluated by the same PD neurologist, and these data were used to make broad comparisons between the monogenic PD cases versus the overall "real world" PD cohort. This report contributes to the scarce literature on R1441C PARK-LRRK2, offering insights into natural history and epidemiological aspects, and provides support for the application of a simple and reliable clinical tool that can improve the inclusion of under-represented patient groups in PD research.
Modulation of the mechanical responses of synovial fibroblasts by osteoarthritis-associated inflammatory stressors

Jamal J, Roebuck MM, Lee SY, Frostick SP, Abbas AA, Merican AM, et al.

Int J Biochem Cell Biol, 2020 09;126:105800.
PMID: 32673644 DOI: 10.1016/j.biocel.2020.105800

OBJECTIVES: To compare mechanobiological response of synovial fibroblasts (SFb) from OA patient cohorts under mechanical load and inflammatory stressors for better understanding of SFb homeostatic functions.
METHODS: Primary SFb isolated from knee synovium of OA obese (OA-ob:SFb), OA-pre-obese (OA-Pob:SFb), non-OA arthroscopic (scope:SFb), and non-OA arthroscopic with cartilage damage (scope-CD:SFb) were exposed to OA-conditioned media (OACM), derived from OA obese (OA-ob:CM), OA-pre-obese (OA-Pob:CM), and mechanical stretch at either 0 %, 6 % or 10 % for 24 h. Differences in the mRNA levels of genes involved in extracellular matrix production, inflammation and secretory activity were measured.
RESULTS: Despite the significant BMI differences between the OA-ob and OA-Pob groups, OA-Pob has more patients with underlying dyslipidaemia, and low-grade synovitis with higher levels of secreted proteins, CXCL8, COL4A1, CCL4, SPARC and FGF2 in OA-Pob:CM. All primary SFb exhibited anti-proliferative activity with both OA-CM. Mechanical stretch stimulated lubricin production in scope:SFb, higher TGFβ1 and COL1A1 expressions in scope-CD:SFb. OA-Pob:CM stimulated greater detrimental effects than the OA-ob:CM, with higher pro-inflammatory cytokines, IL1β, IL6, COX2 and proteases such as aggrecanases, ADAMTS4 and ADAMTS5, and lower ECM matrix, COL1A1 expressions in all SFb. OA-ob:SFb were unresponsive but expressed higher pro-inflammatory cytokines under OA-Pob:CM treatment.
CONCLUSION: Both mechanical and inflammatory stressors regulate SFb molecular functions with heterogeneity in responses that are dependent on their pathological tissue of origins. While mechanical stretch promotes a favorable effect with enhanced lubricin production in scope:SFb and TGFβ1 and COL1A1 in scope-CD:SFb, the presence of excessively high OA-associated inflammatory mediators in OA-Pob:CM, predominantly SPARC, CXCL8 and FGF2 drive all SFb regardless of pathology, towards greater pro-inflammatory activities.
Case report: recurrence of Plasmodium vivax malaria due to defective cytochrome P450 2D6 function in Pos Lenjang, Pahang, Malaysia

Mat Salleh NH, Rahman MFA, Samsusah S, De Silva JR, Ng DC, Ghozali AH, et al.

Trans R Soc Trop Med Hyg, 2020 Sep 01;114(9):700-703.
PMID: 32511702 DOI: 10.1093/trstmh/traa042

Five children in Pos Lenjang, Pahang, Malaysia were PCR-positive for vivax malaria and were admitted to the hospital from 5 to 26 July 2019. One of the patients experienced three episodes of recurrence of vivax malaria. Microsatellite analysis showed that reinfection is unlikely. Drug resistance analysis indicated that Riamet (artemether-lumefantrine) is effective. Cytochrome P450 2D6 (CYP2D6) testing showed that this patient has defective CYP2D6 function. Primaquine failure to clear the Plasmodium vivax hypnozoites may be the cause of recurring infections in this patient. This report highlights the need for the development of liver-stage curative antimalarials that do not require metabolism by the CYP2D6 enzyme.
Malaysia Stroke Council guide on acute stroke care service during COVID-19 Pandemic

Wan Asyraf WZ, Ah Khan YK, Chung LW, Kee HF, Irene L, Ang CL, et al.

Med J Malaysia, 2020 05;75(3):311-313.
PMID: 32467554

On the 18th of March 2020, the Malaysia government declared a movement control order (MCO) due to the unprecedented COVID-19 pandemic. Although the majority of patients presented with respiratory-related symptoms, COVID-19 patients may present atypically with neurological manifestations and may even have an increased risk of stroke. The Malaysia Stroke Council is concerned regarding the level of care given to stroke patients during this pandemic. During the recent National Stroke Workflow Steering Committee meeting, a guide was made based on the currently available evidences to assist Malaysian physicians providing acute stroke care in the hospital setting in order to provide the best stroke care while maintaining their own safety. The guide comprises of prehospital stroke awareness, hyperacute stroke care, stroke care unit and intensive care unit admission, post-stroke rehabilitation and secondary prevention practice. We urge continuous initiative to provide the best stroke care possible and ensure adequate safety for both patients and the stroke care team.
A profile of TNFR2+ regulatory T cells and CD103+ dendritic cells in the peripheral blood of patients with asthma

Azid NA, Ahmad S, Boer JC, Al-Hatamleh MAI, Mohammad N, Mohd Ashari NS, et al.

Hum Immunol, 2020 08 06;81(10-11):634-643.
PMID: 32771274 DOI: 10.1016/j.humimm.2020.07.006

The interaction of tolerogenic CD103+ dendritic cells (DCs) with regulatory T (Tregs) cells modulates immune responses by inducing immune tolerance. Hence, we determined the proportion of these cells in the peripheral blood mononuclear cells (PBMC) of asthmatic patients. We observed lower trends of CD11b-CD103+ DCs and CD86 within CD11b-CD103+ DCs, while increased levels of Foxp3 expressing CD25+/-TNFR2+ cells in asthmatics. There was a positive correlation in the expression of Foxp3 within CD3+CD4+CD25+TNFR2+ Tregs and CD11b-CD103+ as well as the expression of CD86 within HLA-DR+CD11c+CD11b-CD103+ DCs. In conclusion, we suggest that the increased levels of Tregs in blood could continuously suppress the T helper 2 (Th2) cells activation in the circulation which is also supported by the increase of anti-inflammatory cytokines IL-10 and TNF. Overall, functional immunoregulation of the regulatory cells, particularly Tregs, exhibit immune suppression and induce immune tolerance linked with the immune activation by the antigen presenting cells (APC).
Symptom reduction in palliative care from single session mindful breathing: a randomised controlled trial

Look ML, Tan SB, Hong LL, Ng CG, Yee HA, Lim LY, et al.

BMJ Support Palliat Care, 2021 Dec;11(4):433-439.
PMID: 32788274 DOI: 10.1136/bmjspcare-2020-002382

CONTEXT: There has been increasing evidence of the role of mindfulness-based interventions in improving various health conditions. However, the evidence for the use of mindfulness in the palliative care setting is still lacking.
OBJECTIVES: The objective of our study was to determine the efficacy of a single session of 20 min mindful breathing in alleviating multiple symptoms in palliative care.
METHODS: Adult palliative care in patients with at least one symptom scoring ≥5/10 based on the Edmonton Symptom Assessment Scale (ESAS) were recruited from September 2018 to December 2018. Recruited patients were randomly assigned to either 20 min mindful breathing and standard care or standard care alone.
RESULTS: Forty patients were randomly assigned to standard care plus a 20 min mindful breathing session (n=20) or standard care alone (n=20). There was statistically significant reduction of total ESAS score in the mindful breathing group compared with the control group at minute 20 (U=98, n 1 = n 2 = 20, mean rank 1 = 15.4, mean rank 2 = 25.6, median reduction 1 = 6.5, median reduction 2 = 1.5, z=-2.763, r=0.3, p=0.005).
CONCLUSION: Our results provided evidence that a single session of 20 min mindful breathing was effective in reducing multiple symptoms rapidly for palliative care patients.
Fulltext Recent population expansion of longtail tuna Thunnus tonggol (Bleeker, 1851) inferred from the mitochondrial DNA markers

Syahida Kasim N, Mat Jaafar TNA, Mat Piah R, Mohd Arshaad W, Mohd Nor SA, Habib A, et al.

PeerJ, 2020;8:e9679.
PMID: 32844067 DOI: 10.7717/peerj.9679

The population genetic diversity and demographic history of the longtail tuna Thunnus tonggol in Malaysian waters was investigated using mitochondrial DNA D-loop and NADH dehydrogenase subunit 5 (ND5). A total of 203 (D-loop) and 208 (ND5) individuals of T. tonggol were sampled from 11 localities around the Malaysian coastal waters. Low genetic differentiation between populations was found, possibly due to the past demographic history, dispersal potential during egg and larval stages, seasonal migration in adults, and lack of geographical barriers. The gene trees, constructed based on the maximum likelihood method, revealed a single panmictic population with unsupported internal clades, indicating an absence of structure among the populations studied. Analysis on population pairwise comparison ФST suggested the absence of limited gene flow among study sites. Taken all together, high haplotype diversity (D-loop = 0.989-1.000; ND5 = 0.848-0.965), coupled with a low level of nucleotide diversity (D-loop = 0.019-0.025; ND5 = 0.0017-0.003), "star-like" haplotype network, and unimodal mismatch distribution, suggests a recent population expansion for populations of T. tonggol in Malaysia. Furthermore, neutrality and goodness of fit tests supported the signature of a relatively recent population expansion during the Pleistocene epoch. To provide additional insight into the phylogeographic pattern of the species within the Indo-Pacific Ocean, we included haplotypes from GenBank and a few samples from Taiwan. Preliminary analyses suggest a more complex genetic demarcation of the species than an explicit Indian Ocean versus Pacific Ocean delineation.
Fulltext Detrimental Effects of UVB on Retinal Pigment Epithelial Cells and Its Role in Age-Related Macular Degeneration

Mahendra CK, Tan LTH, Pusparajah P, Htar TT, Chuah LH, Lee VS, et al.

Oxid Med Cell Longev, 2020;2020:1904178.
PMID: 32855763 DOI: 10.1155/2020/1904178

Retinal pigment epithelial (RPE) cells are an essential part of the human eye because they not only mediate and control the transfer of fluids and solutes but also protect the retina against photooxidative damage and renew photoreceptor cells through phagocytosis. However, their function necessitates cumulative exposure to the sun resulting in UV damage, which may lead to the development of age-related macular degeneration (AMD). Several studies have shown that UVB induces direct DNA damage and oxidative stress in RPE cells by increasing ROS and dysregulating endogenous antioxidants. Activation of different signaling pathways connected to inflammation, cell cycle arrest, and intrinsic apoptosis was reported as well. Besides that, essential functions like phagocytosis, osmoregulation, and water permeability of RPE cells were also affected. Although the melanin within RPE cells can act as a photoprotectant, this photoprotection decreases with age. Nevertheless, the changes in lens epithelium-derived growth factor (LEDGF) and autophagic activity or application of bioactive compounds from natural products can reverse the detrimental effect of UVB. Additionally, in vivo studies on the whole retina demonstrated that UVB irradiation induces gene and protein level dysregulation, indicating cellular stress and aberrations in the chromosome level. Morphological changes like retinal depigmentation and drusen formation were noted as well which is similar to the etiology of AMD, suggesting the connection of UVB damage with AMD. Therefore, future studies, which include mechanism studies via in vitro or in vivo and other potential bioactive compounds, should be pursued for a better understanding of the involvement of UVB in AMD.
Dietary patterns in childhood and their effect on gut microbiota-an Asian perspective on atopy risk

Ismail IH, Lay C, H A Majid N, Lee WS, Lee BW, Abdul Latiff AH, et al.

J Allergy Clin Immunol, 2020 11;146(5):1005-1007.
PMID: 32860819 DOI: 10.1016/j.jaci.2020.05.057
Fulltext A novel strategy for community screening of SARS-CoV-2 (COVID-19): Sample pooling method

Lim KL, Johari NA, Wong ST, Khaw LT, Tan BK, Chan KK, et al.

PLoS One, 2020;15(8):e0238417.
PMID: 32857823 DOI: 10.1371/journal.pone.0238417

The rapid global spread of the coronavirus disease (COVID-19) has inflicted significant health and socioeconomic burden on affected countries. As positive cases continued to rise in Malaysia, public health laboratories experienced an overwhelming demand for COVID-19 screening. The confirmation of positive cases of COVID-19 has solely been based on the detection of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) using real-time reverse transcription polymerase chain reaction (qRT-PCR). In efforts to increase the cost-effectiveness and efficiency of COVID-19 screening, we evaluated the feasibility of pooling clinical Nasopharyngeal/Oropharyngeal (NP/OP) swab specimens during nucleic acid extraction without a reduction in sensitivity of qRT-PCR. Pools of 10 specimens were extracted and subsequently tested by qRT-PCR according to the WHO-Charité protocol. We demonstrated that the sample pooling method showed no loss of sensitivity. The effectiveness of the pooled testing strategy was evaluated on both retrospective and prospective samples, and the results showed a similar detection sensitivity compared to testing individual sample alone. This study demonstrates the feasibility of using a pooled testing strategy to increase testing capacity and conserve resources, especially when there is a high demand for disease testing.
Fulltext Development and validation of Malaysia Medication Adherence Assessment Tool (MyMAAT) for diabetic patients

Hatah E, Rahim N, Makmor-Bakry M, Mohamed Shah N, Mohamad N, Ahmad M, et al.

PLoS One, 2020;15(11):e0241909.
PMID: 33157549 DOI: 10.1371/journal.pone.0241909

Medication non-adherence remains a significant barrier in achieving better health outcomes for patients with chronic diseases. Previous self-reported medication adherence tools were not developed in the context of the Malaysia population. The most commonly used tool, MMAS-8, is no longer economical because it requires a license and currently every form used is charged. Hence, there is a need to develop and validate a new medication adherence tool. The Malaysia Medication Adherence Assessment Tool (MyMAAT) was developed by a multidisciplinary team with expertise in medication adherence and health literacy. The face and content validities of the MyMAAT was established by a panel of experts. A total of 495 patients with type 2 diabetes were recruited from the Ministry of Health facilities consisting of five hospitals and five primary health clinics. A test-retest was conducted on 42 of the patients one week following their first data collection. Exploratory factor analysis was performed to evaluate the validity of the MyMAAT. The final item for MyMAAT was compared with SEAMS, HbA1c%, Medication Possession ratio (MPR) score, and pharmacist's subjective assessment for its hypothesis testing validity. The MyMAAT-12 achieved acceptable internal consistency (Cronbach's alpha = 0.910) and stable reliability as the test-retest score showed good to excellent correlation (Spearman's rho = 0.96, p = 0.001). The MyMAAT has significant moderate association with SEAMS (Spearman's rho = 0.44, p = < 0.001) and significant relationship with HbA1c (< 8% and ≥ 8%) (χ2(1) = 13.4, p < 0.001), MPR (χ2(1) = 13.6, p < 0.001) and pharmacist's subjective assessment categories (χ2(1) = 31, p < 0.001). The sensitivity of MyMAAT-12, tested against HbA1c% was 72.9% while its specificity was 43%. This study demonstrates that the MyMAAT-12 together with other methods of assessment may make a better screening tool to identify patients who were non-adherence to their medications.
Proton-Functionalized Graphitic Carbon Nitride for Efficient Metal-Free Destruction of Escherichia coli under Low-Power Light Irradiation

Ng BJ, Musyaffa MK, Er CC, Packiam KAR, Lee WPC, Tan LL, et al.

Chemistry, 2021 Feb 10;27(9):3085-3090.
PMID: 33263935 DOI: 10.1002/chem.202004238

Universal access to clean water has been a global ambition over the years. Photocatalytic water disinfection through advanced oxidation processes has been regarded as one of the promising methods for breaking down microbials. The forefront of this research focuses on the application of metal-free photocatalysts for disinfection to prevent secondary pollution. Graphitic carbon nitride (g-C3 N4 ) has achieved instant attention as a metal-free and visible-light-responsive photocatalyst for various energy and environmental applications. However, the photocatalytic efficiency of g-C3 N4 is still affected by its rapid charge recombination and sluggish electron-transfer kinetics. In this contribution, two-dimensionally protonated g-C3 N4 was employed as metal-free photocatalyst for water treatment and demonstrated 100 % of Escherichia coli within 4 h under irradiation with a 23 W light bulb. The introduction of protonation can modulate the surface charge of g-C3 N4 ; this enhances its conductivity and provides a "highway" for the delocalization of electrons. This work highlights the potential of conjugated polymers in antibacterial application.
Self-improving dystrophic epidermolysis bullosa: First report of clinical, molecular, and genetic characterization of five patients from Southeast Asia

Bishnoi P, Ng YZ, Wei H, Tan EC, Lunny DP, Wong XFCC, et al.

Am J Med Genet A, 2021 02;185(2):625-630.
PMID: 33258232 DOI: 10.1002/ajmg.a.61975

Self-improving dystrophic epidermolysis bullosa is a rare subtype of dystrophic epidermolysis bullosa (DEB) characterized by significant improvement in skin fragility within the first few years of life. Genetic inheritance has previously been reported as autosomal dominant or recessive with both forms harboring mutations in COL7A1. To date, there have been no reports of this rare clinical entity from various Southeast Asian ethnicities. Here, we describe the clinical and molecular features of five patients from the Southeast Asia region who presented with predominantly acral-distributed blisters and erosions in the first few days of life. Blistering resolved over several months, without appearance of new blisters. By immunofluorescence, intraepidermal retention of Type VII collagen was observed in all patient skin biopsies when investigated with antibody staining. Genetic analysis of four patients revealed pathogenic variants in COL7A1 which have not been previously reported. The clinical diagnosis in these rare patients is confirmed with molecular histology and genetic characterization.
Fulltext A reverse transcription loop-mediated isothermal amplification for broad coverage detection of Asian and African Zika virus lineages

Teoh BT, Chin KL, Samsudin NI, Loong SK, Sam SS, Tan KK, et al.

BMC Infect Dis, 2020 Dec 11;20(1):947.
PMID: 33308203 DOI: 10.1186/s12879-020-05585-4

BACKGROUND: Early detection of Zika virus (ZIKV) infection during the viremia and viruria facilitates proper patient management and mosquito control measurement to prevent disease spread. Therefore, a cost-effective nucleic acid detection method for the diagnosis of ZIKV infection, especially in resource-deficient settings, is highly required.
METHODS: In the present study, a single-tube reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay was developed for the detection of both the Asian and African-lineage ZIKV. The detection limit, strain coverage and cross-reactivity of the ZIKV RT-LAMP assay was evaluated. The sensitivity and specificity of the RT-LAMP were also evaluated using a total of 24 simulated clinical samples. The ZIKV quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assay was used as the reference assay.
RESULTS: The detection limit of the RT-LAMP assay was 3.73 ZIKV RNA copies (probit analysis, P ≤ 0.05). The RT-LAMP assay detected the ZIKV genomes of both the Asian and African lineages without cross-reacting with other arthropod-borne viruses. The sensitivity and specificity of the RT-LAMP assay were 90% (95% CI = 59.6-98.2) and 100% (95% CI = 78.5-100.0), respectively. The RT-LAMP assay detected ZIKV genome in 9 of 24 (37.5%) of the simulated clinical samples compared to 10 of 24 (41.7%) by qRT-PCR assay with a high level of concordance (κ = 0.913, P
The influence of omega-3 supplementation on vitamin D levels in humans: a systematic review and dose-response meta-analysis of randomized controlled trials

Alhabeeb H, Kord-Varkaneh H, Tan SC, Găman MA, Otayf BY, Qadri AA, et al.

Crit Rev Food Sci Nutr, 2020 Dec 25.
PMID: 33356450 DOI: 10.1080/10408398.2020.1863905

BACKGROUND: Inconsistencies exist with regard to the influence of omega-3 supplementation on 25-hydroxyvitamin D (25(OH)D) levels, which could be attributed to many factors, such as the duration and dose of omega-3 supplementation, and individuals' baseline 25(OH)D levels. Therefore, to address the inconsistencies, we conducted a systematic review and dose-response meta-analysis to accurately determine the effect of omega-3 supplementation on 25(OH)D levels in humans.
METHODS: We performed a comprehensive literature search in Web of Science, PubMed/Medline, Scopus, and Embase databases from inception up to January 2020. We included only randomized controlled trials (RCTs). We used weighted mean difference (WMD) with 95% confidence interval (CI) to assess the influence of omega-3 supplementation on serum 25(OH)D levels using the random-effects model.
RESULTS: Our pooled results of 10 RCTs demonstrated an overall significant increase in 25(OH)D levels following omega-3 intake (WMD = 3.77 ng/ml, 95% CI: 1.29, 6.25). In addition, 25(OH)D levels were significantly increased when the intervention duration lasted >8 weeks and when the baseline serum 25(OH)D level was ˂20 ng/ml. Moreover, omega-3 intake ≤1000 mg/day resulted in higher 25(OH)D levels compared to omega-3 intake >1000 mg/day.
CONCLUSION: In conclusion, omega-3 supplementation increased 25(OH)D concentrations, particularly with dosages ≤1000 mg/day and intervention durations >8 weeks.

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