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Fulltext Cognitive Impairment and Its Associated Risk Factors in the Elderly With Type 2 Diabetes Mellitus

Suain Bon R, Ariaratnam S, Mat Saher Z, Mohamad M, Lee FS

Front Psychiatry, 2021;12:669725.
PMID: 34744807 DOI: 10.3389/fpsyt.2021.669725

Cognitive impairment is not only common but may also act as a precursor for dementia. Moreover, diabetes mellitus has been shown to promote the progression of dementia. This study aims to determine the prevalence of cognitive impairment and its associated risk factors among the elderly patients having type 2 diabetes mellitus (T2DM) in Hospital Kuala Lumpur, Malaysia. This is a cross-sectional study involving 113 participants who were attending the physician clinic. The participants were selected using the universal sampling method. The tools included a sociodemographic questionnaire, the Montreal Cognitive Assessment, the Depression Anxiety Stress Scale, and the Mini-International Neuropsychiatry Interview. Descriptive analysis was performed and followed by multiple logistic regression. The prevalence of cognitive impairment, depressive disorder, and anxiety disorder was 46.9, 10.6, and 2.7%, respectively. Indians (aOR = 4.90, 95% CI = 1.57-15.27) as well as participants who had completed their secondary (aOR = 0.34; 95% CI = 0.12-0.96) and tertiary (aOR = 0.05; 95% CI = 0.01-0.26) levels of education were significantly associated with cognitive impairment. The prevalence of cognitive impairment was high as well as significantly associated with the ethnicity and education levels of the elderly participants. Indeed both secondary and tertiary education decreased the odds ratio of developing cognitive impairment when compared with no formal and primary education. To determine and reduce the potential risk factors which contribute to cognitive impairment, an early diagnosis of T2DM is crucial. The early detection and treatment of T2DM as well as its associated risk factors are key factors in protecting against cognitive impairment.
Fulltext Diagnostic power of resting-state fMRI for detection of network connectivity in Alzheimer's disease and mild cognitive impairment: A systematic review

Ibrahim B, Suppiah S, Ibrahim N, Mohamad M, Hassan HA, Nasser NS, et al.

Hum Brain Mapp, 2021 06 15;42(9):2941-2968.
PMID: 33942449 DOI: 10.1002/hbm.25369

Resting-state fMRI (rs-fMRI) detects functional connectivity (FC) abnormalities that occur in the brains of patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). FC of the default mode network (DMN) is commonly impaired in AD and MCI. We conducted a systematic review aimed at determining the diagnostic power of rs-fMRI to identify FC abnormalities in the DMN of patients with AD or MCI compared with healthy controls (HCs) using machine learning (ML) methods. Multimodal support vector machine (SVM) algorithm was the commonest form of ML method utilized. Multiple kernel approach can be utilized to aid in the classification by incorporating various discriminating features, such as FC graphs based on "nodes" and "edges" together with structural MRI-based regional cortical thickness and gray matter volume. Other multimodal features include neuropsychiatric testing scores, DTI features, and regional cerebral blood flow. Among AD patients, the posterior cingulate cortex (PCC)/Precuneus was noted to be a highly affected hub of the DMN that demonstrated overall reduced FC. Whereas reduced DMN FC between the PCC and anterior cingulate cortex (ACC) was observed in MCI patients. Evidence indicates that the nodes of the DMN can offer moderate to high diagnostic power to distinguish AD and MCI patients. Nevertheless, various concerns over the homogeneity of data based on patient selection, scanner effects, and the variable usage of classifiers and algorithms pose a challenge for ML-based image interpretation of rs-fMRI datasets to become a mainstream option for diagnosing AD and predicting the conversion of HC/MCI to AD.
Neuroimaging Functional Magnetic Resonance Imaging Task-Based Dorsolateral Prefrontal Cortex Activation Following 12 Weeks of Cosmos caudatus Supplementation Among Older Adults With Mild Cognitive Impairment

You YX, Shahar S, Mohamad M, Rajab NF, Haron H, Che Din N, et al.

J Magn Reson Imaging, 2021 12;54(6):1804-1818.
PMID: 34080265 DOI: 10.1002/jmri.27762

BACKGROUND: Cosmos caudatus (CC) is traditional Asian vegetable, commonly consumed among the Southeast Asian population. It has been reported to be high in flavonoids and might potentially improve brain activity among older adults with mild cognitive impairment (MCI). The effect of CC in brain activation improvement using neuroimaging is yet to be discovered.
PURPOSE: To investigate the effects of CC supplement on brain activity using functional magnetic resonance imaging (fMRI) among older adults with MCI.
STUDY TYPE: Prospective, randomized, double-blind, placebo-controlled trial.
POPULATION/SUBJECTS: Twenty older adults with mild cognitive impairment (60-75 years old), 14 of them (70%) were female subjects.
FIELD STRENGTH/SEQUENCE: A 3.0-T, T1-weighted anatomical images, T2*-weighted imaging data, A single shot, gradient echo-echo planar imaging (EPI) sequence.
ASSESSMENT: All subjects were asked to consume two 500 mg capsules of either CC supplement or placebo (maltodextrin) daily for 12 weeks. Cognitive function was measured using validated neuropsychological tests (i.e. Mini-mental State Examination and Digit Span) and task-based fMRI (N-back and Stroop Color Word Test) at baseline and 12th week. Brodmann's area 9, 46 and anterior cingulate cortex were selected as the regions of interest to define dorsolateral prefrontal cortex (DLPFC) in fMRI analysis.
STATISTICAL TESTS: Normality test was performed with the Shapiro-Wilk test. Two-way repeated ANOVA determined the intervention effects of the CC supplementation on brain activity after adjustments for covariates. Significance level at P
Fulltext Is There Any Relationship Between Biochemical Indices and Anthropometric Measurements With Dorsolateral Prefrontal Cortex Activation Among Older Adults With Mild Cognitive Impairment?

You YX, Shahar S, Mohamad M, Rajab NF, Che Din N, Lau HJ, et al.

Front Hum Neurosci, 2021;15:765451.
PMID: 35046782 DOI: 10.3389/fnhum.2021.765451

Working memory is developed in one region of the brain called the dorsolateral prefrontal cortex (DLPFC). The dysfunction of this region leads to synaptic neuroplasticity impairment. It has been reported that several biochemical parameters and anthropometric measurements play a vital role in cognition and brain health. This study aimed to investigate the relationships between cognitive function, serum biochemical profile, and anthropometric measurements using DLPFC activation. A cross-sectional study was conducted among 35 older adults (≥60 years) who experienced mild cognitive impairment (MCI). For this purpose, we distributed a comprehensive interview-based questionnaire for collecting sociodemographic information from the participants and conducting cognitive tests. Anthropometric values were measured, and fasting blood specimens were collected. We investigated their brain activation using the task-based functional MRI (fMRI; N-back), specifically in the DLPFC region. Positive relationships were observed between brain-derived neurotrophic factor (BDNF) (β = 0.494, p < 0.01) and Mini-Mental State Examination (MMSE) (β = 0.698, p < 0.01); however, negative relationships were observed between serum triglyceride (β = -0.402, p < 0.05) and serum malondialdehyde (MDA) (β = -0.326, p < 0.05) with right DLPFC activation (R 2 = 0.512) while the participants performed 1-back task after adjustments for age, gender, and years of education. In conclusion, higher serum triglycerides, higher oxidative stress, and lower neurotrophic factor were associated with lower right DLPFC activation among older adults with MCI. A further investigation needs to be carried out to understand the causal-effect mechanisms of the significant parameters and the DLPFC activation so that better intervention strategies can be developed for reducing the risk of irreversible neurodegenerative diseases among older adults with MCI.
Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?: A Systematic Review and Meta-analysis

Nattabi HA, Sharif NM, Yahya N, Ahmad R, Mohamad M, Zaki FM, et al.

Acad Radiol, 2017 Oct 18.
PMID: 29054676 DOI: 10.1016/j.acra.2017.09.002

RATIONALE AND OBJECTIVE: This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules.
METHODS: PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve.
RESULTS: After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively.
CONCLUSION: Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.
Effect of natural heat convection on fractional MHD second-grade fluid in an infinite vertically oscillating cylinder with Hankel transform

Uddin S, Mehmood OU, Mohamad M, Roslan R, Khan I, Mohamed A

Heliyon, 2023 Feb;9(2):e13210.
PMID: 36814629 DOI: 10.1016/j.heliyon.2023.e13210

In this paper, we studied the effect of a magnetic field on the non-isothermal second-grade fluid confined in a vertically oscillating cylinder. The flow solution is magnetized using the perpendicular magnetic field. The resultant fluid flow is due to the oscillating boundary motion and buoyancy force. Here, the MHD flow is modeled using the Caputo-Fabrizio non-integer derivative approach. The exact solution of the governing continuity, momentum and energy equations is obtained by means of Laplace and finite Hankel transforms. The commercial simulation software, Mathematica is used for calculating the roots of the Bessel function. The effects of dimensionless parameters such as Grashof and Prandtl numbers, magnetic field and fractional parameters on the second-grade fluid flow are analyzed. Heat transfer is high at a small Prandtl number. Velocity correlates positively with Grashof number and magnetic field, and negatively with Prandtl number. The heat and mass transfer results obtained from both conventional and fractional models are compared as well.
Fulltext Evaluating the sensitivity of a commercial dengue NS1 antigen-capture ELISA for early diagnosis of acute dengue virus infection

Kumarasamy V, Chua SK, Hassan Z, Wahab AH, Chem YK, Mohamad M, et al.

Singapore Med J, 2007 Jul;48(7):669-73.
PMID: 17609831

INTRODUCTION: The aim of this report is to establish an accurate diagnosis of acute dengue virus infection early, in order to provide timely information for the management of patients and early public health control of dengue outbreak.
METHODS: 224 serum samples from patients with a clinical diagnosis of acute dengue infection, which were subsequently confirmed by laboratory tests, were used to evaluate the performance of a commercially-available dengue NS1 antigen-capture ELISA kit.
RESULTS: The dengue NS1 antigen-capture ELISA gave an overall sensitivity rate of 93.3 percent (209/224). The sensitivity rate was significantly higher in acute primary dengue (97.4 percent) than in acute secondary dengue (68.8 percent). In comparison, the virus isolation gave an overall positive isolation rate of 64.7 percent, with a positive rate of 70.8 percent and 28.1 percent, for acute primary dengue and acute secondary dengue, respectively. Molecular detection of dengue RNA by RT-PCR gave an overall positive detection rate of 63.4 percent, with a positive rate of 62.5 percent and 68.8 percent, for acute primary dengue and acute secondary dengue, respectively. Of the 224 acute serum samples from patients with laboratory-confirmed acute dengue infection, dengue IgM was detected in 88 specimens, comprising 68 acute primary dengue specimens and 20 acute secondary dengue specimens. NS1 antigen-capture ELISA kit gave an overall sensitivity rate of 88.6 percent in the presence of anti-dengue IgM and 96.3 percent in the absence of anti-dengue IgM.
CONCLUSION: Of the 224 acute serum samples, the sample ages of 166 acute serum samples are known. The positive detection rate of dengue NS1 antigen-capture ELISA, on the whole, was higher than the other three established diagnostic test methods for laboratory diagnosis of acute dengue infection.
Mini review of microplastic pollutions and its impact on the environment and human health

Azfaralariff A, Mat Lazim A, Amran NH, Mukhtar NH, Bakri ND, Azrihan NN, et al.

Waste Manag Res, 2023 Jul;41(7):1219-1226.
PMID: 36883418 DOI: 10.1177/0734242X231155395

In recent years, the environmental pollution of microplastics (MPs) has increasingly drawn our attention. MPs are small fragments of plastics that are commonly dispersed in the environment. The accumulation of environmental MPs is due to population growth and urbanization, while natural disasters such as hurricanes, flooding and human activity may influence their distribution. The leaching of chemicals from MPs raises a significant safety problem and environmental approaches aimed at reducing the use and recycling of plastics, with the replacement by bioplastics and wastewater treatment developments are called for. This summary also helps in demonstrating the connection between terrestrial and freshwater MPs and wastewater treatment plants as the major contributors to environmental MPs by discharges of sludge and effluent. More research on the classification, detection, characterization and toxicity of MPs are essential to enable greater options and solutions. Control initiatives need to intensify the comprehensive study of MP waste control and management information programmes in the fields of institutional engagement, technological research and development, legislation and regulation. A comprehensive quantitative analysis approach for MPs should be created in the future, and more reliable traceability analysis methods should be built to examine further its environmental activity and existence, where this should be done to improve scientific research on MP pollution in terrestrial, freshwater and marine environments and hence, develop more scientific and rational control policies.
Revising and exploring the variations in methodologies for establishing the diagnostic reference levels for paediatric PET/CT imaging

Alhorani Q, Alkhybari E, Rawashdeh M, Sabarudin A, Latiff RA, Al-Ibraheem A, et al.

Nucl Med Commun, 2023 Nov 01;44(11):937-943.
PMID: 37615527 DOI: 10.1097/MNM.0000000000001748

PET-computed tomography (PET/CT) is a hybrid imaging technique that combines anatomical and functional information; to investigate primary cancers, stage tumours, and track treatment response in paediatric oncology patients. However, there is debate in the literature about whether PET/CT could increase the risk of cancer in children, as the machine is utilizing two types of radiation, and paediatric patients have faster cell division and longer life expectancy. Therefore, it is essential to minimize radiation exposure by justifying and optimizing PET/CT examinations and ensure an acceptable image quality. Establishing diagnostic reference levels (DRLs) is a crucial quantitative indicator and effective tool to optimize paediatric imaging procedures. This review aimed to distinguish and acknowledge variations among published DRLs for paediatric patients in PET/CT procedures. A search of relevant articles was conducted using databases, that is, Embase, Scopus, Web of Science, and Medline, using the keywords: PET-computed tomography, computed tomography, PET, radiopharmaceutical, DRL, and their synonyms. Only English and full-text articles were included, with no limitations on the publication year. After the screening, four articles were selected, and the review reveals different DRL approaches for paediatric patients undergoing PET/CT, with primary variations observed in patient selection criteria, reporting of radiation dose values, and PET/CT equipment. The study suggests that future DRL methods for paediatric patients should prioritize data collection in accordance with international guidelines to better understand PET/CT dose discrepancies while also striving to optimize radiation doses without compromising the quality of PET/CT images.
Fulltext Maternal Serum and Breast Milk Adiponectin: The Association with Infant Adiposity Development

Mohamad M, Loy SL, Lim PY, Wang Y, Soo KL, Mohamed HJJ

Int J Environ Res Public Health, 2018 Jun 12;15(6).
PMID: 29895806 DOI: 10.3390/ijerph15061250

The prevalence of childhood obesity is increasing at an alarming rate in Malaysia. Metabolic changes during pregnancy are critical to the development of infant adiposity, due to imbalanced adipokines production. Hence, we aimed to investigate the association of maternal serum and breast milk adipokines with infant adiposity development. The study was conducted from April 2010 until December 2012. A total of 155 healthy pregnant mothers aged 19 to 40 years were recruited during the first and second trimester in Kelantan, Malaysia. Data consisted of maternal sociodemographic details, anthropometry and clinical biochemistry analysis; and the infant’s anthropometry and feeding patterns. Maternal fasting serum and breast milk samples were analysed for adiponectin and leptin levels. Data collection was performed in the second and third trimester of pregnancy, and continued with follow-up visits at birth, two, six, and 12 months postpartum. Multiple linear regression (MLR) analyses were performed to examine the associations between maternal serum and breast milk adiponectin and leptin and infant adiposity development. MLR models showed that, in the first year, as maternal serum and breast milk adiponectin increased, infant weight, BMI-for-age Z scores and abdominal circumference significantly decreased (p < 0.05). Maternal serum and/or breast milk adiponectin was associated with first-year infant adiposity development.
Comparisons of automated machine learning (AutoML) in predicting whistleblowing of academic dishonesty with demographic and theory of planned behavior

Rahman RA, Masrom S, Mohamad M, Sari EN, Saragih F, Rahman ASA

MethodsX, 2023 Dec;11:102364.
PMID: 37744883 DOI: 10.1016/j.mex.2023.102364

Machine learning has been very promising in solving real problems, but the implementation involved difficulties mainly for the inexpert data scientists. Therefore, this paper presents an automated machine learning (AutoML) to simplify and accelerate the modeling tasks. Focused on Python and RapidMiner rapid modeling tools, Tree-based Pipeline Optimization Tool (TPOT) and AutoModel were used. This paper presents a comprehensive comparison between these tools with regard to the prediction accuracy and Area Under Curve (AUC) in classifying real cases of whistleblowing academic dishonesty among undergraduate students of two universities in Indonesia. Additionally, the correlations weight from demographic and Theory of Planned Behavior (TOB) attributes in the different machine learning models are also discussed. All the machine learning algorithms from TPOT and AutoModel are considerable powerful to generate good accuracy level (between 70-93% of AUC) in classifying both cases of whistleblowing and non-whistleblowing on the hold-out samples from the testing process. Generally, based on the validation results of the prediction models, demographic attributes presented more importance than the TBP attributes. The findings of this study will be a great interest of many research scholars to conduct a more in-depth analysis on AutoML for many domains mainly in education and academic misconduct fields.•AutoML is the first of its kind to be empirically compared between TPOT and AutoModel in an application to predict academic dishonesty whistleblowing.•Besides accuracy performances of the AutoML, the proportion of the variance of each attribute from demographic and Theory of Planned Behavior (TPB) is also presented in the prediction models of academic dishonesty whistleblowing.•AutoML is a convenient and reproducible rapid modeling method of machine learning to be used in many kinds of prediction problem.
Fulltext Effect of nutritional intervention on nutritional status among children with disorders of amino acid and nitrogen metabolism (AANMDs): A scoping review

Lim JY, Amit N, Ali NM, Leong HY, Mohamad M, Rajikan R

Intractable Rare Dis Res, 2021 Nov;10(4):246-256.
PMID: 34877236 DOI: 10.5582/irdr.2021.01124

Disorders of amino acid and nitrogen metabolism (AANMDs) occur due to an enzyme deficiency in a normal biochemical pathway. Nutritional intervention is recognized as the mainstay of treatment for children diagnosed with AANMD. Hence, this scoping review aimed to identify the nutritional interventions available in managing AANMD disorders and their effects on nutritional status. A systematic search using PRISMA Extension for Scoping Reviews (PRISMA-ScR) method was conducted across 4 databases: PubMed, ScienceDirect (Elsevier), EBSCOhost and Cochrane Central Register of Controlled Trials (CENTRAL). Inclusion criteria for the study to be selected are: subjects aged less than 18-year-old, article published in English, utilized an experimental design and published within the past 20 years. A total of 22 articles were included in this review. The majority of the subjects are boys (55.6%) and employed a randomized controlled trial (RCT) study design (45.4%). Nutritional interventions were categorized into 4 categories which are: "protein substitute" (n = 5), "protein substitute with modified composition" (n = 6), "nutrient supplementation (n=8)", and "distribution and dosage of protein substitute (n = 3)". The most frequently assessed outcomes were biochemical parameters that gauge the effectiveness of metabolic control (68.2%). Overall, "protein substitute enriched with inhibitive amino acids", "long-chain polyunsaturated fatty acids supplementation", and "evenly distributed protein substitute" demonstrated beneficial effects towards the nutritional status, especially in terms of biochemical parameters. In summary, nutritional intervention plays a significant role in improving the nutritional status of AANMD patients. Further investigations of nutritional intervention among AANMD children using a meta-analysis approach are necessary for better comprehension of their impact in management of AANMD disorders.
Optimization of stabilized anaerobic landfill leachate treatment using ozonation with metallic compound using response surface methodology

Zakaria SNF, Aziz HA, Mohamad M, Mohamad HM, Sulaiman MF

Water Environ Res, 2023 Nov;95(11):e10941.
PMID: 37828655 DOI: 10.1002/wer.10941

Malaysia encounters a consistent rise in the generation of solid waste and leachate on a daily basis. It should also be noted that leachate has a low degree of biodegradability (BOD5 /chemical oxygen demand [COD]), as shown by its BOD5 /COD ratio. Its high toxicity levels significantly threaten the environment, water bodies, and human well-being. High concentrations of COD, color, and ammoniacal nitrogen (NH3 -N) in leachate prevent this wastewater from being allowed to be discharged directly into the water body. Therefore, an effective process to remove the pollutant is desired. The aims of this study are to investigate the performance of ozonation with two metallic compounds, ZrCl4 and SnCl4 , and optimize their performance using response surface methodology (RSM). In this study, the performance of ozonation with ZrCl4 (O3 /ZrCl4 ) recorded better pollutant removals compared with the ozonation with tin tetrachloride (O3 /SnCl4 ), as seen in the removals of 99.8%, 93.5%, and 46.3% for color, COD, and NH3 -N, respectively. These removals were achieved by following the experimental model (optimum experiment condition) generated by RSM at O3 dosage of 31 g/m3 , COD and ZrCl4 dosage ratio (COD, mg/L/ZrCl4 , mg/L) of 1:1.35, with the pH solution of 8.78 and reaction time of 89 min. The R2 of each parameter for this model was recorded as 0.999 (COD), 0.999 (color), and 0.998 (NH3 -N), respectively. These data indicated that the model is well fitted as the predicted data by statistical calculation and in good agreement with the actual data. PRACTITIONER POINTS: The performance of O3 /ZrCl4 and O3 /SnCl4 was examined for remediate stabilized landfill leachate. The performance of O3 /ZrCl4 and O3 /SnCl4 was optimized using RSM, and a set of experimental models was generated and tested. O3 /ZrCl4 recorded the higher removal of COD, color, and NH3 -N compared with O3 /SnCl4 . At best condition, both methods recorded removal as 89% to 99.8% of pollutants in leachate and product clear effluent. This finding gives a new approach to treat landfill leachate effectively and efficiently.
Fulltext Risk factors for tuberculosis-related death among adults with drug-sensitive pulmonary tuberculosis in Selangor, Malaysia from 2013 to 2019: a retrospective cohort study using surveillance data

Suhairi MH, Mohamad M, Isa MR, Mohd Yusoff MAS, Ismail N

BMJ Open, 2024 Feb 26;14(2):e080144.
PMID: 38413152 DOI: 10.1136/bmjopen-2023-080144

OBJECTIVES: Due to the paucity of literature on risk factors for tuberculosis (TB)-related death, we determine the sociodemographic and clinical risk factors associated with TB-related deaths among adult pulmonary TB (PTB) patients on treatment in Selangor, Malaysia.
DESIGN: Retrospective cohort study.
SETTING: Routinely collected primary care data from all government TB clinics in Selangor.
PARTICIPANTS: Data of 24 570 eligible adult PTB patients from 2013 to 2019 were obtained from Selangor's State Health Department surveillance records. We included PTB patients aged at least 15 years old at the time of diagnosis with complete documentation of the dates of diagnosis, treatment initiation, end of treatment/follow-up and treatment outcomes. We excluded patients whose diagnoses were changed to non-TB, post-mortem TB diagnosis and multidrug-resistant TB (MDR-TB) patients.
PRIMARY AND SECONDARY OUTCOME MEASURES: TB-related death, determined from the recorded physicians' consensus during the TB mortality meeting.
RESULTS: TB-related death was significantly associated with far (adjusted HR (aHR) 9.98, 95% CI 4.28 to 23.28) and moderately advanced (aHR 3.23, 95% CI 1.43 to 7.31) radiological findings at diagnosis; concurrent TB meningitis (aHR 7.67, 95% CI 4.53 to 12.98) and miliary TB (aHR 6.32, 95% CI 4.10 to 9.74) involvement; HIV positive at diagnosis (aHR 2.81, 95% CI 2.21 to 3.57); Hulu Selangor (aHR 1.95, 95% CI 1.29 to 2.93), Klang (aHR 1.53, 95% CI 1.18 to 1.98) and Hulu Langat (aHR 1.31, 95% CI 1.03 to 1.68) residing districts; no formal education (aHR 1.70, 95% CI 1.23 to 2.35); unemployment (aHR 1.54, 95% CI 1.29 to 1.84), positive sputum smear acid-fast bacilli (AFB) at diagnosis (aHR 1.51, 95% CI 1.22 to 1.85); rural residency (aHR 1.39, 95% CI 1.13 to 1.72) and advancing age (aHR 1.03, 95% CI 1.02 to 1.03).
CONCLUSIONS: Far and moderately advanced radiological findings, concurrent TB meningitis and miliary TB involvement, HIV positive, Hulu Selangor, Klang and Hulu Langat residing districts, no formal education, unemployment, positive sputum smear AFB, rural residency and advancing age are risk factors of TB-related death. Our findings should assist in identifying high-risk patients requiring interventions against TB-related death.
National and local diagnostic reference levels for adult18F-FDG and CT in Jordanian PET/CT: findings and implications in practice

Alhorani Q, Alkhybari E, Rawashdeh M, Sabarudin A, Latiff RA, Al-Ibraheem A, et al.

J Radiol Prot, 2024 Mar 07;44(1).
PMID: 38387102 DOI: 10.1088/1361-6498/ad2c62

This study aims to report the findings of Jordanian national diagnostic reference level (NDRL) survey for fluorodeoxyglucose (18F-FDG) and local diagnostic reference level (LDRL) of computed tomography (CT) used for attenuation correction and anatomical localisation (AC-AL); and AC and diagnostic CT (AC-DX) within the context of whole-body WB and half-body HB adult oncology PET/CT scanning. Two-structured questionnaires were prepared to gather the necessary information: dosimetry data, patient demographics, equipment specification, and acquisition protocols for identified18F-FDG PET/CT procedures. The NDRL and achievable dose were reported based on the 75th and 50th percentiles for18F-FDG administered activity (AA), respectively. The LDRL was reported based on the 50th percentile for (CTDIvol) and (DLP). Data from 562 patients from four Jordanian PET/CT centres were collected. The survey revealed that Jordanian NDRL for AA (303 MBq) was within the acceptable range compared to the published-peer NDRL data (240-590 MBq). However, the18F-FDG AA varied across the participated PET/CT centres. The reported LDRL CTDIvoland DLP of CT used for (AC-AL) was 4.3 mGy and 459.3 mGy.cm for HB CT scan range, and 4.1 mGy and 659.9 mGy.cm for WB CT scans. The reported LDRL for CTDIvoland DLP for HB CT was higher when compared with the United Kingdom (3.2 mGy and 310 mGy.cm). Concurrently, in the context of WB CT, the reported values (i.e. CTDIvol and DLP) were also higher than both Kuwait (3.6 mGy and 659 mGy.cm) and Slovenia (3.6 mGy and 676 mGy.cm). The reported HB CT(AC-DX) was higher than Nordic, New Zealand and Swiss NDRLs and for WB (AC-DX) CT it was higher than Swiss NDRLs. This study reported the first Jordanian NDRL for18F-FDG and LDRL for HB and WB CT associated with18F-FDG PET/CT scans. This data is useful for Jordanian PET/CT centres to compare their LDRL to the suggested DRLs and utilise it in the process of optimising CT radiation doses.
No evidence of carbon storage usage for seed production in 18 dipterocarp masting species in a tropical rain forest

Igarashi S, Yoshida S, Kenzo T, Sakai S, Nagamasu H, Hyodo F, et al.

Oecologia, 2024 Mar;204(3):717-726.
PMID: 38483587 DOI: 10.1007/s00442-024-05527-w

Most canopy species in lowland tropical rain forests in Southeast Asia, represented by Dipterocarpaceae, undergo mast reproduction synchronously at community level during a general flowering event. Such events occur at irregular intervals of 2-10 years. Some species do not necessarily participate in every synchronous mast reproduction, however. This may be due to a lack of carbohydrate resources in the trees for masting. We tested the hypothesis that interspecific differences in the time required to store assimilates in trees for seed production are due to the frequency of masting and/or seed size in each species. We examined the relationship between reproductive frequency and the carbon accumulation period necessary for seed production, and between the seed size and the period, using radiocarbon analysis in 18 dipterocarp canopy species. The mean carbon accumulation period was 0.84 years before seed maturation in all species studied. The carbon accumulation period did not have any significant correlation with reproductive frequency or seed size, both of which varied widely across the species studied. Our results show that for seed production, dipterocarp masting species do not use carbon assimilates stored for a period between the masting years, but instead use recent photosynthates produced primarily in a masting year, regardless of the masting interval or seed size of each species. These findings suggest that storage of carbohydrate resources is not a limiting factor in the masting of dipterocarps, and that accumulation and allocation of other resources is important as a precondition for participation in general flowering.
Fulltext Use of Combination of Oral Levothyroxine and Liothyronine in Severe Hypothyroidism With Massive Pericardial Effusion

Wong PS, Lim SW, Tong CV, Mohamad M, Hussein Z

J ASEAN Fed Endocr Soc, 2022;37(2):106-112.
PMID: 36578894 DOI: 10.15605/jafes.037.02.17

Thyroid hormone plays an important role in cardiovascular function. Pericardial effusions are commonly seen in cases of severe hypothyroidism. However, large to massive pericardial effusions with cardiac tamponade are exceptionally rare. Herein, we present two cases of severe hypothyroidism with massive pericardial effusion. Our first case demonstrates that a patient with large pericardial effusion can be managed conservatively with aggressive thyroid hormone replacement therapy. In our second case, pericardiocentesis was performed in addition to thyroid hormone replacement therapy as the underlying aetiology of effusion could not be reasonably limited to hypothyroidism. These two cases served to highlight and demonstrate rapid normalisation of thyroid function test by using aggressive oral thyroid hormone replacement therapy using liothyronine, in combination with levothyroxine, which led to resolution of pericardial effusion and prevent its re-accumulation.
Fulltext Brain Activation during Addition and Subtraction Tasks In-Noise and In-Quiet

Abd Hamid AI, Yusoff AN, Mukari SZ, Mohamad M

Malays J Med Sci, 2011 Apr;18(2):3-15.
PMID: 22135581 MyJurnal

In spite of extensive research conducted to study how human brain works, little is known about a special function of the brain that stores and manipulates information-the working memory-and how noise influences this special ability. In this study, Functional magnetic resonance imaging (fMRI) was used to investigate brain responses to arithmetic problems solved in noisy and quiet backgrounds.
Investigating knowledge of DRLs, image quality and radiation dose in PET/CT and CT imaging among medical imaging professionals

Alhorani Q, Al-Ibraheem A, Rawashdeh M, Alkhybari E, Sabarudin A, A Latiff R, et al.

Heliyon, 2024 May 15;10(9):e30030.
PMID: 38707442 DOI: 10.1016/j.heliyon.2024.e30030

OBJECTIVE: To investigate the knowledge of diagnostic reference levels (DRLs), image quality, radiation dose and protocol parameters among Jordanian medical imaging professionals (MIPs) involved in PET/CT and CT scan procedures.
MATERIALS AND METHODS: A questionnaire was designed and distributed to MIPs in Jordan. The survey comprised four sections: demographic data, MIP knowledge on dose/protocol parameters, image quality, and DRLs. Statistical analyses were performed utilizing Pearson's correlation, t-tests, ANOVA, and linear regression, with a significance level of 95 % and a p-value threshold of <0.05.
RESULTS: The study involved 147 participants. Most respondents were male (76.2 %), and most were aged 26-35 years (44.2 %). Approximately 51 % held a bachelor's degree, and the most common range of experience was 3-5 years (28.6 %). Participants showed a moderate level of knowledge regarding dose and protocol parameters, with a mean score of 61.8 %. The mean scores for knowledge of image quality and DRLs were 45.2 % and 44.8 %, respectively. The age group of the MIPs and the total experience were found to have a significant impact on the knowledge of the dose and protocol parameters, as well as the DRLs. Additionally, experience was found to have a significant influence on knowledge of the dose and protocol parameters. The study revealed a positive and significant effect of MIPs' knowledge of dose/protocol parameters and image quality on their knowledge of DRLs.
CONCLUSIONS: This study indicates that professionals across five specialties who are engaged in PET/CT and CT imaging possess a moderate understanding of dosage and protocol parameters. However, there is a notable gap in knowledge regarding DRLs and image quality. To address this issue, it is recommended that MIPs actively engage in educational programs emphasizing exposure parameters and their impact on image quality. Additionally, access to comprehensive education and training programs will enable MIPs to grasp the complexities of DRLs and their implications, facilitating their implementation in clinical practice.
Fulltext Predictors of grit among medical students: a study at a Malaysian Public University

Ibrahim N, Mohamad M, Abdul-Razak S, Mohamed-Yassin MS, Baharudin N

BMC Med Educ, 2024 Jul 23;24(1):791.
PMID: 39044251 DOI: 10.1186/s12909-024-05798-0

BACKGROUND: Previous literature has demonstrated associations between grit and positive educational and psychological outcomes, such as higher academic grades, lower attrition rates in medical training, and protection from burnout. However, the predictors of grit have yet to be studied, particularly among medical students in Malaysia. This study aimed to determine the level of grit and its predictors among Malaysian medical students.
METHODS: A cross-sectional study was conducted among 123 medical students from a public university in Malaysia. Data on sociodemographic and educational characteristics were collected. The student's personality traits were determined using the Big Five Inventory (BFI), while grit was assessed using the validated 7-item Short Grit Scale (Grit-S). Grit was expressed as a mean score, ranging from 1 (not at all gritty) to 5 (extremely gritty). Multiple linear regression was used to determine the association between the predictors (personality, sociodemographic and educational characteristics) and grit among these students.
RESULTS: The mean grit score was 3.43 (SD 0.57). Based on the multiple linear regression analysis, the grit score was significantly predicted by three personality traits which were extraversion, b = 0.2 (95% CI: 0.07-0.32), agreeableness, b = 0.28 (95% CI: 0.12-0.44) and conscientiousness, b = 0.6 (95% CI: 0.42-0.77). A 1-point increase in the mean extraversion, agreeableness, and conscientiousness scores would independently increase these students' mean grit scores by 0.2, 0.28, and 0.6, respectively. The sociodemographic and educational characteristics did not significantly predict grit among Malaysian medical students.
CONCLUSIONS: The mean grit score among Malaysian medical students is comparable to other medical students in Asia. Extraversion, agreeableness, and conscientiousness personality traits were associated with higher grit. As grit is a dynamic trait, appropriate interventions should be implemented to foster and increase it among these students.

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