Displaying publications 61 - 80 of 118 in total

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  1. Naqiyah I, Rohaizak M, Meah FA, Nazri MJ, Sundram M, Amram AR
    Singapore Med J, 2005 Jul;46(7):344-6.
    PMID: 15968447
    The occurrence of urinary bladder paragangliomas is rare. A 12-year-old Chinese girl who presented with history of blurring of vision was found to have grade IV hypertensive retinopathy. Investigations revealed a phaeochromocytoma on the posterior wall of the urinary bladder. A partial cystectomy with right ureter reimplantation was undertaken and her hypertension was promptly controlled. The diagnosis and management of this rare tumour is discussed.
  2. Navedur Rehman, Chin Chwen Ch’ng, Thavin Kumar Mathana Sundram, Eugenie Sin Sing Tan, Chew Kek Lee, Chung Keat Tan3
    MyJurnal
    Introduction: Acne vulgaris is a chronic inflammatory dermatosis caused by Propionibacterium acnes. Clinicians are constantly attempting to discover the best antibiotic regimes in treating acne vulgaris. This study compares two regimens in terms of efficacy, tolerability, compliance and recurrence rate to make recommendation on which is the best regime. Methods: An open-labelled prospective randomized investigator-blinded interventional study was carried on moderate acne vulgaris patients. Patients were assigned to treatment arm at enrolment followed by fol- low-up and maintenance visits. Demographic data were collected at enrolment and questionnaire enquiring acne condition, general health and quality of life impairment were filled at every visit followed by blinded dermatologist assessment. Antibiotic tablets were provided based on assigned arm until follow-up 3. Results: 26 mild acne vulgaris patients aged 17 to 29 years were recruited. Physician assessment based on GAGS and photo assessment analysis showed an overall significant change (p0.05) were found between regimens. Similarly, patient self-perceived assessment and CADI assessment also showed overall significant changes (p
  3. Al-Qazaz HKh, Hassali MA, Shafie AA, Sulaiman SA, Sundram S, Morisky DE
    Diabetes Res Clin Pract, 2010 Nov;90(2):216-21.
    PMID: 20832888 DOI: 10.1016/j.diabres.2010.08.012
    AIMS:
    To translate and examine the psychometric properties of the Malaysian version of the Morisky Medication Adherence Scale (MMAS) among patients with type 2 diabetes.

    METHODS:
    A standard "forward-backward" procedure was used to translate MMAS into Malay language. It was later validated on a convenience sample of 223 type 2 diabetes outpatients between May and September 2009. Reliability was tested for internal consistency. Validity was confirmed using convergent and known group validity.

    RESULTS:
    Employing the recommended scoring method, the mean±SD of MMAS scores was 6.13±1.72. Moderate internal consistency was found (Cronbach's α=0.675), the test-retest reliability value was 0.816 (p<0.001). A positive correlation between the eight- and four-item MMAS was found (r=0.792; p<0.01). A significant relationship between MMAS categories and HbA1c categories (χ(2)=20.261; p≥0.001) was found. The MMAS sensitivity and specificity, with positive and negative predictive values were 77.61%, 45.37%, 46.84% and 76.56%, respectively.

    CONCLUSIONS:
    The findings of this validation study indicate that the Malaysian version of the MMAS is a reliable and valid measure of medication adherence which can now be used.
  4. Karupaiah T, Chuah KA, Chinna K, Pressman P, Clemens RA, Hayes AW, et al.
    Sci Rep, 2019 09 20;9(1):13666.
    PMID: 31541144 DOI: 10.1038/s41598-019-49911-6
    We conducted this cross-sectional population study with a healthy multi-ethnic urban population (n = 577) in Malaysia, combining nutritional assessments with cardiometabolic biomarkers defined by lipid, atherogenic lipoproteins, inflammation and insulin resistance. We found diametrically opposing associations of carbohydrate (246·6 ± 57·7 g, 54·3 ± 6·5%-TEI) and fat (total = 64·5 ± 19·8 g, 31·6 ± 5·5%-TEI; saturated fat = 14·1 ± 2·7%-TEI) intakes as regards waist circumference, HDL-C, blood pressure, glucose, insulin and HOMA2-IR as well as the large-LDL and large-HDL lipoprotein particles. Diets were then differentiated into either low fat (LF, <30% TEI or <50 g) or high fat (HF, >35% TEI or >70 g) and low carbohydrate (LC, <210 g) or high carbohydrate (HC, >285 g) which yielded LFLC, LFHC, HFLC and HFHC groupings. Cardiometabolic biomarkers were not significantly different (P > 0.05) between LFLC and HFLC groups. LFLC had significantly higher large-LDL particle concentrations compared to HFHC. HOMA-IR2 was significantly higher with HFHC (1·91 ± 1·85, P 1.7 in the HFHC group was 2.43 (95% CI: 1·03, 5·72) times more compared to LFLC while odds of having large-LDL <450 nmol/L in the HFHC group was 1.91 (95% CI: 1·06, 3·44) more compared to latter group. Our data suggests that a HFHC dietary combination in Malaysian adults is associated with significant impact on lipoprotein particles and insulin resistance.
  5. Sundram ER, Norsa'adah B, Mohamad H, Moy FM, Husain NRN, Shafei MN
    Oman Med J, 2019 Jan;34(1):49-55.
    PMID: 30671184 DOI: 10.5001/omj.2019.08
    Objectives: We sought to determine the effectiveness of a voice care program among primary school teachers in a northeastern district in Malaysia.
    Methods: We conducted a randomized community trial in eight primary schools in a northeastern district in Malaysia. The self-administered and validated Malay-Voice Handicap Index-10 (M-VHI-10) questionnaire was used to assess overall voice handicap scores pre-intervention and eight weeks post-intervention. Teachers with a score of five or more (n = 86) were randomized into intervention (n = 41) and control groups (n = 45). The intervention group received portable voice amplifiers and vocal hygiene instruction, which was delivered by lectures and a booklet. The control group was not prescribed any intervention.
    Results: The sociodemographic, lifestyle, and occupational characteristics of the teachers (except maximum number of students per class) were similar between both groups. The baseline M-VHI-10 scores between both groups were also comparable. After the intervention phase, there was a significant effect observed in the total M-VHI-10 scores (p = 0.021, F-stat (df): 5.33 (1,79)) between both groups after controlling for the maximum number of students per class.
    Conclusions: Our results support the use of voice amplification in adjunct with vocal hygiene instruction as a prevention and treatment modality to reduce voice handicap among teachers. Our study demonstrated encouraging evidence on the low-cost voice care program as well as the success of group and workplace-based approaches in the school setting.
  6. Al-Qazaz HK, Syed Sulaiman SA, Hassali MA, Shafie AA, Sundram S
    Practical Diabetes International, 2010;27(6):238-241a.
    DOI: 10.1002/pdi.1495
    The aims of this study were to translate the Michigan Diabetes Knowledge Test (MDKT) into the Malaysian language, and to examine the psychometric properties of the Malaysian version. A standard translation procedure was used to create the Malaysian version of the MDKT from the original English version. A convenience sample of 307 outpatients with type 2 diabetes was identified between May and October 2009. All data were collected from the Penang General Hospital, Penang, Malaysia. Instruments consisted of the Malaysian version of the MDKT and a socio-demographic questionnaire. Medical records were reviewed for haemoglobin A1c (HbA1c) levels and other clinical data. Reliability was tested for internal consistency using Cronbach’s alpha coefficient. Employing the recommended scoring method, the mean±SD of MDKT scores was 7.88±3.01. Good internal consistency was found (Cronbach’s alpha = 0.702); the test-retest reliability value was 0.894 (p<0.001). For known group validity, a significant relationship between MDKT categories and HbA1c categories (chi-square = 21.626; p≥0.001) was found. The findings of this validation study indicate that the Malaysian version of the MDKT is a reliable and valid measure of diabetes knowledge which can now be used in clinical and research practice.
    KEY WORDS: diabetes knowledge; validation; Michigan test; translation
    Study site: Diabetes Clinic, Hospital Pulau Pinang, Pulau Pinang, Malaysia.
  7. Fatin AM, Mathana Sundram TK, Tan SSE, Seghayat MS, Lee CK, Rehman N, et al.
    Skin Res Technol, 2020 Jul;26(4):564-570.
    PMID: 31916334 DOI: 10.1111/srt.12831
    INTRODUCTION: Periorbital hyperpigmentation (POH) is among the commonest esthetic and dermatological complaints. Despite its frequency, there are inadequate information detailing its incidence and prevalence. This subsequently leads to lack of comprehensive POH classification and stratification of impact on an individual's general well'being. Malaysia, a multiracial country with an expansive expatriate population, provides a unique opportunity to identify demographics of POH and subsequently attempts to group this esthetic and dermatological entity.

    OBJECTIVE: This study aims to develop a new and clinically relevant POH classification system and to measure impact on quality of life of POH individuals.

    METHODS: One hundred patients with POH were enrolled, of which all underwent clinical assessment by a clinician. Objective assessment with mexameter and digital analysis were performed. All recruited patients also completed a questionnaire based on dermatology life quality index (DLQI).

    RESULTS: Assessments noted the commonest type of POH among the subjects was vascular (51%) with the least being pigmentary (6%). The location of POH majority involved both the upper and lower eyelids (65%). DLQI scoring shows that a majority (58%) did not disrupt their quality of life.

    CONCLUSION: Vascular type POH was the frequent most form observed, and involvement tends to occur on both eyelids. A majority of noted that POH does not affect they QOL, but the due consideration must be given in those whom are moderately and minimally affected. A thorough and comprehensive holistic approach is required in managing POH despite its focal presentation as it does affect a patient's quality of life.

  8. Karupaiah T, Chuah KA, Chinna K, Matsuoka R, Masuda Y, Sundram K, et al.
    Lipids Health Dis, 2016 Aug 17;15(1):131.
    PMID: 27535127 DOI: 10.1186/s12944-016-0301-9
    BACKGROUND: Mayonnaise is used widely in contemporary human diet with widespread use as a salad dressing or spread on breads. Vegetable oils used in its formulation may be a rich source of ω-6 PUFAs and the higher-PUFA content of mayonnaise may be beneficial in mediating a hypocholesterolemic effect. This study, therefore, evaluated the functionality of mayonnaise on cardiometabolic risk within a regular human consumption scenario.

    METHODS: Subjects underwent a randomized double-blind crossover trial, consuming diets supplemented with 20 g/day of either soybean oil-based mayonnaise (SB-mayo) or palm olein-based mayonnaise (PO-mayo) for 4 weeks each with a 2-week wash-out period. The magnitude of changes for metabolic outcomes between dietary treatments was compared with PO-mayo serving as the control. The data was analyzed by ANCOVA using the GLM model. Analysis was adjusted for weight changes.

    RESULTS: Treatments resulted in significant reductions in TC (diff = -0.25 mmol/L; P = 0.001), LDL-C (diff = -0.17 mmol/L; P = 0.016) and HDL-C (diff = -0.12 mmol/L; P  0.05). Lipoprotein particle change was significant with large LDL particles increasing after PO-mayo (diff = +63.2 nmol/L; P = 0.007) compared to SB-mayo but small LDL particles remained unaffected. Plasma glucose, apolipoproteins and oxidative stress markers remained unchanged.

    CONCLUSIONS: Daily use with 20 g of linoleic acid-rich SB-mayo elicited reductions in TC and LDL-C concentrations without significantly changing LDL-C:HDL-C ratio or small LDL particle distributions compared to the PO-mayo diet.

    TRIAL REGISTRATION: This clinical trial was retrospectively registered with the National Medical Research Register, National Institute of Health, Ministry of Health Malaysia, (NMRR-15-40-24035; registered on 29/01/2015; https://www.nmrr.gov.my/fwbPage.jsp?fwbPageId=ResearchISRForm&fwbAction=Update&fwbStep=10&pk.researchID=24035&fwbVMenu=3&fwbResearchAction=Update ). Ethical approval was obtained from the National University of Malaysia's Medical Ethics Committee (UKM 1.5.3.5/244/SPP/NN-054-2011, approved on 25/05/2011).

  9. Fairus S, Leow SS, Mohamed IN, Tan YA, Sundram K, Sambanthamurthi R
    Sci Rep, 2018 05 29;8(1):8217.
    PMID: 29844318 DOI: 10.1038/s41598-018-26384-7
    Plant phenolics are being increasingly consumed globally with limited scientific and clinical evidence pertaining to safety and efficacy. The oil palm fruit contains a cocktail of phenolics, and palm oil production results in high volumes of aqueous by-products enriched in phenolics and bioactives. Several lines of evidence from in vitro and in vivo animal studies confirmed that the aqueous extract enriched in phenolics and other bioactives collectively known as oil palm phenolics (OPP) is safe and has potent bioactivity. A phase one clinical trial was conducted to evaluate the safety and effects of OPP in healthy volunteers. In this single-blind trial, 25 healthy human volunteers were supplemented with 450 mg gallic acid equivalent (GAE)/day of OPP or control treatments for a 60-day period. Fasting blood and urine samples were collected at days 1, 30 and 60. Medical examination was performed during these trial interventions. All clinical biochemistry profiles observed throughout the control and OPP treatment period were in the normal range with no major adverse effect (AE) or serious adverse effect (SAE) observed. Additionally, OPP supplementation resulted in improvement of total cholesterol and LDL-C levels, compared to the control treatment. The outcomes support our previous observations that OPP is safe and may have a protective role in reducing cholesterol levels.
  10. Suppiah TSS, Sundram TKM, Tan ESS, Lee CK, Bustami NA, Tan CK
    Asia Pac J Clin Nutr, 2018 10 3;27(5):1141-1145.
    PMID: 30272862 DOI: 10.6133/apjcn.072018.01
    BACKGROUND AND OBJECTIVES: Acne vulgaris is a common skin condition among adolescents and young adults. Its relationship with the dietary intake is highly debatable and equivocal. This study aimed to identify the association between acne vulgaris and dietary intake among Malaysians.

    METHODS AND STUDY DESIGN: A case-control study was conducted involving 57 acne vulgaris patients and 57 age-, gender- and ethnicity-matched controls. All participants were aged 14 and above. The Comprehensive Acne Severity Scale (CASS) was used to categorise patients (grades 2 to 5) and controls (grades 0 to 1). Information such as the demographics, family history, smoking habits and dietary intake were collected using a self-administered questionnaire.

    RESULTS: In the patient arm, the gender ratio of male to female was 1.5:1. 43 patients (75.4%) had a family history of acne vulgaris. No significant association was found for acne in patients with a history of smoking. Milk consumption was significantly higher in patients (63.2%, n=36) versus controls (43.9%, n=25), (OR=2.19, p<0.05). In addition, chocolate consumption was also significantly higher in patients (43.9%, n=25) versus controls (24.6%, n=14), (OR=2.4, p<0.05). No significant association was found with the intakes of sweets, potatoes, chips, nuts, yoghurt, ice-cream or carbonated drinks.

    CONCLUSIONS: Dietary intake of milk and chocolate may play a role in acne vulgaris. Prospective cohort and intervention studies are recommended to explore whether a causal relationship might obtain.

  11. Zolait A, Radhi N, Alhowaishi MM, Sundram VPK, Aldoseri LM
    Int J Health Care Qual Assur, 2019 May 13;32(4):720-730.
    PMID: 31111785 DOI: 10.1108/IJHCQA-05-2018-0106
    PURPOSE: The purpose of this paper is to examine whether Bahraini individuals accept e-health system and the prominent factors affecting e-health system adoption in Bahrain.

    DESIGN/METHODOLOGY/APPROACH: The authors adopted a quantitative and qualitative approach, i.e., a self-administered questionnaire, unstructured and a semi-structured interview, which were used to collect the data. A questionnaire was distributed to Bahraini residents selected randomly. The framework was based on the technology acceptance model (TAM) and theory of reasoned action (TRA). Important variables from both the TAM model and TRA theory were extracted and jointly used to build the research model.

    FINDINGS: The findings indicated that the most factors affecting e-health adoption are trust, health literacy and attitude. Additionally, people in the private and government sectors understand e-health benefits.

    PRACTICAL IMPLICATIONS: If healthcare professionals understand the factors affecting e-health system adoption from an individual and organisational perspective, then nurses, pharmacists and others will be more conscious about e-health and its adoption status.

    ORIGINALITY/VALUE: E-health system adoption has become increasingly important to governments, individuals, and researchers in recent years. A novel research framework, based on TAM and TRA, was used to produce a new integrated model.

  12. Samsulrizal NH, Khadzran KS, Shaarani SH, Noh AL, Sundram TC, Naim MA, et al.
    Data Brief, 2020 Feb;28:104811.
    PMID: 31871974 DOI: 10.1016/j.dib.2019.104811
    Stevia rebaudiana (S. rebaudiana) is a herbaceous and perennial plant belonging to Asteraceae family. The genus stevia is well known as a natural producer of sweetener comprising non-caloric and non-carcinogenic steviol glycosides. In recent years, the capability in producing natural sweetner has increased the demand for S. rebaudiana as substitute of processed sugars. Flowering phase of S. rebaudiana has shown to affect the content of steviol glycosides in the leaves. Steviol glycosides level is the highest at the time of flower bud formation and lowest at time preceding and following flower bud formation. Therefore, sequencing and analysing the genes that are involved in flowering phase will provide platform for gene manipulation in increasing steviol glycosides content. The Stevia transcriptome data that include two stages of growth (before flowering and after flowering), were obtained using Illumina RNA-seq technology and can be accessed at NCBI Sequence Read Archive under Accession No. SRX6362785 and SRX6362784.
  13. Balakumar P, Handa S, Alqahtani A, Alqahtani T, Khan NA, LakshmiRaj RS, et al.
    Cardiovasc Toxicol, 2022 Feb 10.
    PMID: 35143015 DOI: 10.1007/s12012-022-09724-y
    Among numerous choices in cardiovascular therapies used for the management of hypertension and heart failure, drugs affecting the renin-angiotensin-aldosterone system (RAAS) hold substantial therapeutic roles. Therapies aimed at modifying the RAAS and its overactivation are employed for the management of various insidious disorders. In the pharmacologic perspective, RAAS is one of the frequently manipulated systems for the management of hypertension, heart failure, myocardial infarction, and renal disease. The RAAS pharmacologic interventions principally include the ACE inhibitors, the angiotensin II-AT1 receptor blockers, the mineralocorticoid receptor antagonists, and the direct renin inhibitors. In addition, therapeutic implication of ACE2/angiotensin (1-7)/Mas receptor activation using various ligands is being explored owing to their anti-inflammatory, anti-fibrotic, vasodilatory, and cardiovascular defensive roles. Moreover, being considered as the counter-regulatory arm of AT1 receptor, the potential role of AT2 receptor activation using selective AT2 receptor agonist is currently investigated for its efficacy in pulmonary complications. As an important regulator of fluid volume, blood pressure, and cardiovascular-renal function, the RAAS has been documented as a diversified intricate system with several therapeutic possibilities coupled with their fundamental structural and functional modulatory roles in cardiovascular, renal, and other systems. The RAAS possesses a number of regulatory, deregulatory, and counter-regulatory axes of physiopathologic importance in health and disease. The counter-regulatory arms of the RAAS might play an essential role in mitigating cardiovascular, renal, and pulmonary pathologies. In light of this background, we sought to explore the classical and counter-regulatory axes/arms of the RAAS and their imperative roles in physiologic functions and disease pathogenesis.
  14. Al-Qazaz HKh, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, Al-Nuri R, et al.
    Int J Clin Pharm, 2011 Dec;33(6):1028-35.
    PMID: 22083724 DOI: 10.1007/s11096-011-9582-2
    BACKGROUND: Most of interventions that have attempted to improve medication adherence in type 2 diabetes have been educational; on the assumption that knowledge regarding diabetes might affect patients' adherence to their treatment regimen.
    OBJECTIVES: The purpose of the study was to investigate any association of knowledge and medication adherence with glycemic control in patients with type 2 diabetes mellitus. Setting The study was conducted at the Diabetes Outpatients Clinic, Hospital Pulau Pinang.
    METHODS: A cross-sectional study was conducted with a convenience sample of 540 adult patients with type 2 diabetes attending the clinic. A questionnaire including previously validated Michigan Diabetes Knowledge Test and Morisky Medication Adherence Scale was used and the patients' medical records were reviewed for haemoglobin A1C (HbA1C) levels and other disease-related information. A total of 35 (6.48%) patients were excluded after data collection due to lack of HbA1C results.
    RESULTS: Five hundred and five patients were included in the final analysis, with a mean age of 58.15 years (SD = 9.16), 50.7% males and median HbA1C of 7.6 (IQR was 6.7-8.9). The median total knowledge score was 7.0 (IQR was 5.0-10.0) while the median adherence score was 6.5 (IQR was 4.75-7.75). Significant correlations were found between the three variables (HbA1C, knowledge and adherence). A significantly higher score for knowledge and adherence (P < 0.05) was found in those patients with lower HbA1C. Higher diabetes knowledge, higher medication adherence and using mono-therapy were significant predictors of good glycemic control in the multivariate analysis.
    CONCLUSION: Patients' knowledge about diabetes is associated with better medication adherence and better glycemic control. In addition to other factors affecting medication adherence and glycemic control, healthcare providers should pay attention to knowledge about diabetes that the patients carry towards medication adherence.

    Study site: Diabetes Outpatients Clinic, Hospital Pulau Pinang, Pulau Pinang, Malaysia
  15. Al-Qazaz HK, Hassali MA, Shafie AA, Syed Sulaiman SA, Sundram S
    Res Social Adm Pharm, 2011 Jun;7(2):180-91.
    PMID: 21272545 DOI: 10.1016/j.sapharm.2010.04.005
    BACKGROUND: Diabetic patients' experience and knowledge about their medication play an important role in determining the success of long-term adherence in their disease management.
    OBJECTIVE: This study aimed to explore diabetic patients' experience and knowledge about diabetes and its medication and to understand the factors contributing to medication adherence in Malaysian population.
    METHODS: A qualitative research approach was adopted to gain a better understanding of the current perceptions and knowledge held by diabetic patients. Twelve patients were interviewed using a semi-structured interview guide. Saturation point of the interview was reached after the 10th interview, and no more new themes emerged from the subsequent 2 interviews. All interviews were transcribed verbatim and analyzed by means of a standard content analysis framework.
    RESULTS: A total of 4 themes were identified from the interview analysis: knowledge about diabetes and its medication, experiences of adverse effects of medication, issues related to adherence, and the impact of medical and family relationships on well-being. Most of the patients were aware of the disease known as diabetes but unaware which type of diabetes they were suffering from. None of the participants knew the adverse effects of their medication, and most of them considered it to be safe. Financial barriers, forgetfulness, self-medication, and quality of relationships with doctor and family members seem to be the factors that challenge adherence in our sample of diabetic patients.
    CONCLUSION: This study identified a number of key themes that might be useful in enhancing the awareness of experiences, knowledge, adherence, and attitudes of Malaysian patients with diabetes. More efforts should be taken to estimate how diabetic patients take their medication, and a well-planned educational program is also required to educate and encourage patients to practice a healthy lifestyle.
  16. Balakumar P, Alqahtani T, Alqahtani A, Lakshmiraj RS, Singh G, Rupeshkumar M, et al.
    Curr Drug Metab, 2022;23(11):897-904.
    PMID: 36017834 DOI: 10.2174/1389200223666220825101212
    BACKGROUND: Curcumin is a polyphenolic compound derived from rhizomes of Curcuma longa, the golden spice. Curcumin has drawn much attention in recent years of biomedical research owing to its wide variety of biologic and pharmacologic actions. It exerts antiproliferative, antifibrogenic, anti-inflammatory, and antioxidative effects, among various imperative pharmacologic actions. In spite of its well-documented efficacies against numerous disease conditions, the limited systemic bioavailability of curcumin is a continuing concern. Perhaps, the poor bioavailability of curcumin may have curtailed its significant development from kitchen to clinic as a potential therapeutic agent. Subsequently, there have been a considerable number of studies over decades researching the scientific basis of curcumin's reduced bioavailability and eventually improvement of its bioavailability employing a variety of therapeutic approaches, for instance, in combination with piperine, the bio-active constituent of black pepper. Piperine has remarkable potential to modulate the functional activity of metabolic enzymes and drug transporters, and thus there has been a great interest in the therapeutic application of this widely used spice as alternative medicine and bioavailability enhancer. Growing body of evidence supports the synergistic potential of curcumin against numerous pathologic conditions when administered with piperine.

    CONCLUSION: In light of current challenges, the major concern pertaining to poor systemic bioavailability of curcumin, its improvement, especially in combination with piperine, and the necessity of additional research in this setting are together described in this review. Besides, the recent advances in the potential therapeutic rationale and efficacy of curcumin-piperine combination, a promising duo, against various pathologic conditions are delineated.

  17. Anuar MSK, Hashim AM, Ho CL, Wong MY, Sundram S, Saidi NB, et al.
    World J Microbiol Biotechnol, 2023 Mar 19;39(5):123.
    PMID: 36934342 DOI: 10.1007/s11274-023-03579-3
    In today's fast-shifting climate change scenario, crops are exposed to environmental pressures, abiotic and biotic stress. Hence, these will affect the production of agricultural products and give rise to a worldwide economic crisis. The increase in world population has exacerbated the situation with increasing food demand. The use of chemical agents is no longer recommended due to adverse effects towards the environment and health. Biocontrol agents (BCAs) and biostimulants, are feasible options for dealing with yield losses induced by plant stresses, which are becoming more intense due to climate change. BCAs and biostimulants have been recommended due to their dual action in reducing both stresses simultaneously. Although protection against biotic stresses falls outside the generally accepted definition of biostimulant, some microbial and non-microbial biostimulants possess the biocontrol function, which helps reduce biotic pressure on crops. The application of synergisms using BCAs and biostimulants to control crop stresses is rarely explored. Currently, a combined application using both agents offer a great alternative to increase the yield and growth of crops while managing stresses. This article provides an overview of crop stresses and plant stress responses, a general knowledge on synergism, mathematical modelling used for synergy evaluation and type of in vitro and in vivo synergy testing, as well as the application of synergism using BCAs and biostimulants in reducing crop stresses. This review will facilitate an understanding of the combined effect of both agents on improving crop yield and growth and reducing stress while also providing an eco-friendly alternative to agroecosystems.
  18. Dass SC, Kwok WM, Gibson GJ, Gill BS, Sundram BM, Singh S
    PLoS One, 2021;16(5):e0252136.
    PMID: 34043676 DOI: 10.1371/journal.pone.0252136
    The second wave of COVID-19 in Malaysia is largely attributed to a four-day mass gathering held in Sri Petaling from February 27, 2020, which contributed to an exponential rise of COVID-19 cases in the country. Starting from March 18, 2020, the Malaysian government introduced four consecutive phases of a Movement Control Order (MCO) to stem the spread of COVID-19. The MCO was implemented through various non-pharmaceutical interventions (NPIs). The reported number of cases reached its peak by the first week of April and then started to reduce, hence proving the effectiveness of the MCO. To gain a quantitative understanding of the effect of MCO on the dynamics of COVID-19, this paper develops a class of mathematical models to capture the disease spread before and after MCO implementation in Malaysia. A heterogeneous variant of the Susceptible-Exposed-Infected-Recovered (SEIR) model is developed with additional compartments for asymptomatic transmission. Further, a change-point is incorporated to model disease dynamics before and after intervention which is inferred based on data. Related statistical analyses for inference are developed in a Bayesian framework and are able to provide quantitative assessments of (1) the impact of the Sri Petaling gathering, and (2) the extent of decreasing transmission during the MCO period. The analysis here also quantitatively demonstrates how quickly transmission rates fall under effective NPI implementation within a short time period. The models and methodology used provided important insights into the nature of local transmissions to decision makers in the Ministry of Health, Malaysia.
  19. Esmailiyan M, Amerizadeh A, Vahdat S, Ghodsi M, Doewes RI, Sundram Y
    Curr Probl Cardiol, 2023 Mar;48(3):101034.
    PMID: 34718034 DOI: 10.1016/j.cpcardiol.2021.101034
    High blood pressure (BP) is one of the main modifiable risk factors for cardiovascular disease (CVD) and preventing it greatly reduces the vascular consequences of aging and, along with intensive treatment of hypertension, eliminates a large portion of the burden of CVD-related mortality. Many meta-analyses and studies proved that regular aerobic exercise (AE) reduces BP but most of these studies consider only hypertensive populations or only AE but not resistant exercise or their combination. In this review, we aimed to study the effect of different types of physical activity (PA)/AE on various populations including normotensive, prehypertensive, primary hypertensive, and resistant hypertensive with different comorbidities. We searched PubMed, Web of Science, and Google Scholar for English articles with keywords for physical activity, aerobic exercise, and blood pressure from January 2010 until September 2021. Finally, 24 studies were included. Results showed that chronic or acute AE (long-term or short-term), either alone or as combined with different sessions and programs can reduce systolic and diastolic BP in every group including normotensive, prehypertensive, primary hypertensive, resistant hypertensive individuals and diabetic patients and those with kidney problems but not in people with chronic heart failure. Isometric exercise training showed to be useful in reducing BP in all groups either as low intensity or as high intensity but the rate of reduction was different in terms of gender. AE showed to be effective in terms of BP reduction in a different age range. It can be seen that different types and duration of AE independent of the modality and programs and independent of the BP medical situation of individuals have been successful in terms of BP reduction. For those with chronic heart failure, more concern and help might be needed to decrease BP via exercise.
  20. Roslan ND, Sundram S, Hong LW, Ling KL, Vadamalai G
    Mol Biol Rep, 2023 Nov;50(11):9699-9705.
    PMID: 37676433 DOI: 10.1007/s11033-023-08771-0
    BACKGROUND: Sequence variation has been attributed to symptom variations but has not been investigated in Orange Spotting-Coconut cadang-cadang viroid (OS-CCCVd) infected palms. Likewise, the relationship between Coconut cadang-cadang viroid (CCCVd) variants, Orange Spotting (OS) severity and the accumulation of the viroid in the palms have not been elucidated. This paper describes the characterization of CCCVd variants by cloning and sequencing, followed by correlation with symptom expression.

    METHODS AND RESULTS: Total nucleic acids were extracted from leaf samples harvested from frond 20 of seven Dura × Pisifera (D × P) African oil palm (Elaeis guineensis Jacq.) aged between 13 and 21 years old collected from local plantations. The nucleic acids were fractionated using 5% non-denaturing polyacrylamide gel electrophoresis (PAGE) before being subjected to detection by reverse transcribed polymerase chain reaction (RT-PCR). The PCR products were cloned into a plasmid vector and the sequence of the clones was analyzed. CCCVd variants were quantified using real-time qPCR assay with CCCVd specific primers. Sixteen randomly selected clones of (OP246) had an arbitrary 100% identity with CCCVdOP246 (GeneBank Accession No: HQ608513). Meanwhile, four clones had >93% similarity with several minor sequence variations forming variants of OP234, OP235, OP251 and OP279.

    CONCLUSION: The OS symptoms observed in the field were characterized into three categories based on the size and morphology of the orange spots on the affected fronds. In addition, there was no direct correlation between disease severity and the accumulation of CCCVd variants in oil palm. This finding is the first report describing the sequence variation of the CCCVd RNA and symptom variation in OS oil palm field samples.

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