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Fulltext Can patients make heads or tails of enhanced primary health care (EnPHC)? Experience through their own journey

Johari MZ, Abdullah Z, Mohd Hanafiah AN, Mohammed Nadzri NI, Razli SA, Kong YL

BMC Fam Pract, 2020 09 04;21(1):182.
PMID: 32887562 DOI: 10.1186/s12875-020-01254-2

BACKGROUND: Implementation of the new Enhanced Primary Health Care (EnPHC) intervention aims to improve service quality and experience at primary healthcare clinics; especially to newly diagnosed patients. This was achieved by restructuring and improving existing services to better manage non-communicable diseases amongst patients. Objectives of this study are to explore patients' experiences of the EnPHC intervention, to document their feedback and to determine effects of EnPHC intervention on patients.
METHODS: This phenomenological qualitative study focussed on patients' experiences in relation to EnPHC interventions. Participants were purposely selected from a group of patients who attended the eight intervention primary healthcare clinics in Johor and Selangor regularly for treatment. Data collection was conducted between April to July 2018. Semi-structured interviews were conducted at average an hour per interview for four to five patients per clinic. Interviews were audio recorded, transcribed verbatim, coded and analysed using a thematic analysis approach.
RESULTS: A total of 35 patients participated. Analysis revealed five main themes about patient experiences receiving the EnPHC intervention. These are: (1) health assessment in disease progress monitoring, (2) patient-doctor relationship and continuity of care, (3) professionalism in service delivery, (4) ensuring compliance in achieving health targets and (5) communication skills. Each theme represents an important aspect of the service, how it should be delivered within the patient expectations and how it can improve patient's health through their lens.
CONCLUSION: Even though patients were not able to exactly identify the EnPHC intervention components implemented, they are able to describe the process changes that occurred; enabling them to improve their healthcare status. Engagement is necessary to better inform patients of the EnPHC intervention, its purpose, mechanisms, changes and importance for healthcare. It would reduce resistance and increase awareness amongst patients at the clinic.
Reflexin A, a new indole alkaloid from Rauvolfia reflexa induces apoptosis against colon cancer cells

Fadaeinasab M, Karimian H, Omar H, Taha H, Khorasani A, Banisalam B, et al.

J Asian Nat Prod Res, 2020 May;22(5):474-488.
PMID: 30945944 DOI: 10.1080/10286020.2019.1588888

One new indole alkaloid, reflexin A (1), and two known indoles, macusine B (2) and vinorine (3), were isolated from the bark of Rauvolfia reflexa. Their structures were elucidated by 1D and 2D NMR, UV, IR, and MS spectroscopic analyses. Compound 1 displayed anticancer activity against HCT-116 colon cancer cells with an IC50 value of 30.24 ± 0.75 µM. The results implied that the newly isolated 1 induced apoptosis in HCT-116 cells, suggesting its possible role as an anticancer agent. In vivo acute toxicity study was performed on compound 1 to evaluate its safety profile.
Fulltext Phenolic Compounds as Promising Drug Candidates in Tuberculosis Therapy

Mazlun MH, Sabran SF, Mohamed M, Abu Bakar MF, Abdullah Z

Molecules, 2019 Jul 04;24(13).
PMID: 31277371 DOI: 10.3390/molecules24132449

Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB) remains one of the deadliest, infectious diseases worldwide. The detrimental effects caused by the existing anti-TB drugs to TB patients and the emergence of resistance strains of M. tuberculosis has driven efforts from natural products researchers around the globe in discovering novel anti-TB drugs that are more efficacious and with less side effects. There were eleven main review publications that focused on natural products with anti-TB potentials. However, none of them specifically emphasized antimycobacterial phenolic compounds. Thus, the current review's main objective is to highlight and summarize phenolic compounds found active against mycobacteria from 2000 to 2017. Based on the past studies in the electronic databases, the present review also focuses on several test organisms used in TB researches and their different distinct properties, a few types of in vitro TB bioassay and comparison between their strengths and drawbacks, different methods of extraction, fractionation and isolation, ways of characterizing and identifying isolated compounds and the mechanism of actions of anti-TB phenolic compounds as reported in the literature.
Fulltext Mechanical Performance and Corrosion Behaviour of Diffusion-Bonded A5083 Aluminium and A36 Mild Steel with Gallium Interlayer

Ismail A, Othman NH, Mustapha M, Mohamed Saheed MS, Abdullah Z, Muhammed M, et al.

Materials (Basel), 2022 Sep 13;15(18).
PMID: 36143643 DOI: 10.3390/ma15186331

This article investigated the mechanical performance and corrosion behaviour of a diffusion-bonded A5083 aluminium/A36 mild steel dissimilar joint with a Gallium (Ga) interlayer. The bonding parameters were the bonding temperature (525 and 550 °C), holding time (60 and 120 min) and surface roughness (800 and 1200 grit). Property characterisation was achieved using Scanning Electron Microscopy (SEM), Energy Dispersive X-ray (EDX) analysis, Vickers microhardness tester, Izod impact tester and potentiodynamic polarisation testing. The results revealed that the significance of the bonding parameters was in the order bonding temperature > surface roughness > holding time. Increasing the bonding temperature resulted in an increase in the impact strength and a corresponding reduction in the corrosion rate and microhardness. However, increasing the grit size decreased the microhardness and a corresponding increase in the impact strength and corrosion rate. The impact strength and corrosion rate decreased with the increasing holding time while the microhardness followed a reverse trend. It was also discovered that incorporating the Ga interlayer resulted in a 67.9% improvement in the degradation rate.
Fulltext Development of an Artificial Neural Network Utilizing Particle Swarm Optimization for Modeling the Spray Drying of Coconut Milk

Ming JLK, Anuar MS, How MS, Noor SBM, Abdullah Z, Taip FS

Foods, 2021 Nov 05;10(11).
PMID: 34828988 DOI: 10.3390/foods10112708

Spray drying techniques are one of the methods to preserve and extend the shelf-life of coconut milk. The objective of this research was to create a particle swarm optimization-enhanced artificial neural network (PSO-ANN) that could predict the coconut milk spray drying process. The parameters for PSO tuning were selected as the number of particles and acceleration constant, respectively, for both global and personal best using a 2k factorial design. The optimal PSO settings were recorded as global best, C1 = 4.0; personal best, C2 = 0; and number of particles = 100. When comparing different types of spray drying models, PSO-ANN had an MSE value of 0.077, GA-ANN had an MSE of 0.033, while ANN had an MSE of 0.082. Sensitivity analysis was conducted on all three models to evaluate the significance level of each parameter on the model, and it was discovered that inlet temperature had the most significant influence on the model performance. In conclusion, the PSO-ANN was found to be more effective than ANN but less effective than GA-ANN in predicting the quality of coconut milk powder.
Electronic nicotine delivery system use and its relation to waterpipe smoking among youth in seven Arab countries

Mohammad MS, Aburezq M, AlSaeed N, Abdullah Z, Fayrouz S, Almunefi K, et al.

Prev Med, 2024 Apr 02;182:107945.
PMID: 38574972 DOI: 10.1016/j.ypmed.2024.107945

OBJECTIVES: Electronic Nicotine Delivery System (ENDS) use and Waterpipe Tobacco Smoking (WTS) are reported to be a growing strain of tobacco epidemic among youth in the Arab world. Therefore, we aimed to: (1) estimate the regional prevalence of ENDS use among youth in 7 Arab countries and, (2) to explore the bidirectional relationship between ENDS use and WTS among Arab adolescents.
METHODS: We analyzed data from the World Health Organization Global Youth Tobacco Survey (GYTS 2014-2018) of 18,536 schoolchildren aged 12-16 from Iraq, Mauritania, Morocco, Oman, Qatar, Tunisia, and Yemen. The weighted prevalence was calculated to generate nationally representative estimates. Adjusted multilevel logistic regression models were conducted to assess the association between ENDS use and WTS.
RESULTS: The pooled weighted prevalence of ENDS use was 9.5%. Higher odds of ENDS use were significantly associated with WTS (AOR: 5.26, 95%CI: 4.28-6.46), smoking conventional cigarettes (AOR: 1.54, 95%CI: 1.23-1.94) and first tobacco use prior to the age of 12 (AOR: 1.40, 95%CI: 1.14-1.72). Females and children who were taught in school the dangers of tobacco had less odds of using ENDS.
CONCLUSION: WTS was associated with increased odds of ENDS use by >5 folds, and vice versa. Tobacco consumption at age younger than 12 years was associated with higher odds of ENDS use, but less odds of WTS. Females and those who were taught in school the dangers of tobacco were less likely to report ENDS use.
Fulltext N-(Quinoxalin-2-yl)-4-toluidine

Wan Saffiee WA, Idris A, Aiyub Z, Abdullah Z, Ng SW

Acta Crystallogr Sect E Struct Rep Online, 2008 Dec 10;65(Pt 1):o93.
PMID: 21581731 DOI: 10.1107/S1600536808041160

The aromatic and the aromatic fused-rings in the title compound, C(15)H(13)N(3), open the angle at the planar N atom to 130.07 (13) and 129.98 (13)° in the two independent mol-ecules in the asymmetric unit. The amino N atom of one mol-ecule forms a hydrogen bond to the 4-N atom of an adjacent quinoxalinyl ring, generating a supra-molecular chain.
Fulltext Furo[3,2-c]coumarin-derived Fe3+ Selective Fluorescence Sensor: Synthesis, Fluorescence Study and Application to Water Analysis

Sarih NM, Ciupa A, Moss S, Myers P, Slater AG, Abdullah Z, et al.

Sci Rep, 2020 May 04;10(1):7421.
PMID: 32366859 DOI: 10.1038/s41598-020-63262-7

Furocoumarin (furo[3,2-c]coumarin) derivatives have been synthesized from single step, high yielding (82-92%) chemistry involving a 4-hydroxycoumarin 4 + 1 cycloaddition reaction. They are characterized by FTIR, 1H-NMR, and, for the first time, a comprehensive UV-Vis and fluorescence spectroscopy study has been carried out to determine if these compounds can serve as useful sensors. Based on the fluorescence data, the most promising furocoumarin derivative (2-(cyclohexylamino)-3-phenyl-4H-furo[3,2-c]chromen-4-one, FH), exhibits strong fluorescence (ФF = 0.48) with long fluorescence lifetime (5.6 ns) and large Stokes' shift, suggesting FH could be used as a novel fluorescent chemosensor. FH exhibits a highly selective, sensitive and instant turn-off fluorescence response to Fe3+ over other metal ions which was attributed to a charge transfer mechanism. Selectivity was demonstrated against 13 other competing metal ions (Na+, K+, Mg2+, Ca2+, Mn2+, Fe2+, Al3+, Ni2+, Cu2+, Zn2+, Co2+, Pb2+ and Ru3+) and aqueous compatibility was demonstrated in 10% MeOH-H2O solution. The FH sensor coordinates Fe3+ in a 1:2 stoichiometry with a binding constant, Ka = 5.25 × 103 M-1. This novel sensor has a limit of detection of 1.93 µM, below that of the US environmental protection agency guidelines (5.37 µM), with a linear dynamic range of ~28 (~2-30 µM) and an R2 value of 0.9975. As an exemplar application we demonstrate the potential of this sensor for the rapid measurement of Fe3+ in mineral and tap water samples demonstrating the real-world application of FH as a "turn off" fluorescence sensor.
Fulltext White light employing luminescent engineered large (mega) Stokes shift molecules: a review

Mohd Yusof Chan NN, Idris A, Zainal Abidin ZH, Tajuddin HA, Abdullah Z

RSC Adv, 2021 Apr 07;11(22):13409-13445.
PMID: 35423891 DOI: 10.1039/d1ra00129a

Large (mega) Stokes shift molecules have shown great potential in white light emission for optoelectronic applications, such as flat panel display technology, light-emitting diodes, photosensitizers, molecular probes, cellular and bioimaging, and other applications. This review aims to summarize recent developments of white light generation that incorporate a large Stokes shift component, key approaches to designing large Stokes shift molecules, perspectives on future opportunities, and remaining challenges confronting this emerging research field. After a brief introduction of feasible pathways in generating white light, exemplifications of large Stokes shift molecules as white light candidates from organic and inorganic-based materials are illustrated. Various possible ways to design such molecules have been revealed by integrating the photophysical mechanisms that are essential to produce red-shifted emission upon photoexcitation, such as excited state intramolecular proton transfer (ESIPT), intramolecular charge transfer (ICT), excited state geometrical relaxation or structural deformation, aggregation-induced emission (AIE) alongside the different formations of aggregates, interplay between monomer and excimer emission, host-guest interaction, and lastly metal to ligand charge transfer (MLCT) via harvesting triplet state. Furthermore, previously reported fluorescent materials are described and categorized based on luminescence behaviors on account of the Stokes shifts value. This review will serve as a rationalized introduction and reference for researchers who are interested in exploring large or mega Stokes shift molecules, and will motivate new strategies along with instigation of persistent efforts in this prominent subject area with great avenues.
Fulltext Antioxidant Properties and Gastroprotective Effects of 2-(Ethylthio)Benzohydrazones on Ethanol-Induced Acute Gastric Mucosal Lesions in Rats

Nazarbahjat N, Kadir FA, Ariffin A, Abdulla MA, Abdullah Z, Yehye WA

PLoS One, 2016;11(6):e0156022.
PMID: 27272221 DOI: 10.1371/journal.pone.0156022

A series of new 2-(ethylthio)benzohydrazone derivatives (1-6) were prepared and characterised by IR, 1H NMR, and 13C NMR spectroscopy and mass spectrometry. The newly prepared compounds were screened for their in vitro antioxidant activities using free radical scavenging 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP) assays. Among them, most powerful antioxidant, compound 1 has been selected in order to illustrate anti-ulcer effect on ethanol-induced gastric mucosal lesions in rats. Four groups of Sprague Dawley rats were respectively treated with 10% Tween 20 as ulcer control group, 20 mg/kg omeprazole as reference group, 50 mg/kg and 100 mg/kg compound 1 as experimental animals. Macroscopically, ulcer control group showed extensive hemorrhagic lesions of gastric mucosa compared with omeprazole or compound 1. Rats pre-treated with compound 1 showed increased in gastric pH and gastric mucus. Histologically, ulcer control group showed severe damage to gastric mucosa with edema and leucocytes infiltration of submucosal layer. In immunohistochemical analysis, rats which were pre-treated with compound 1 showed up-regulation of HSP70 and down-regulation of Bax proteins. In conclusion, the gastroprotective effect of compound 1 may be due to its antioxidant activity, and/or due to up-regulation of HSP70 and down-regulation of Bax protein in stained tissue section.
Fulltext General health status and psychological impact of COVID19 pandemic and curfew on children aging 3 to 12 years

Shamsah A, Aburezq M, Abdullah Z, Khamissi F, Almaateeq B, AlAlban F, et al.

Front Child Adolesc Psychiatry, 2022;1:1034492.
PMID: 39817277 DOI: 10.3389/frcha.2022.1034492

BACKGROUND: COVID-19 is an infectious disease that was declared as a pandemic and public health emergency in late 2019 and has impacted children's mental health worldwide. This study aimed to assess the general and mental health status of children during different stages of COVID-19 pandemic, and to identify the associated factors.
METHODS: A cross-sectional study conducted on children aging 3 to 12 years in Kuwait during three different stages of COVID19 pandemic (pre-total curfew, during total curfew, and post-total curfew). The psychological status was assessed using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders criteria.
RESULTS: Of 2157 children between the age of 3 to 12 years old, 853 (39.5%) reported increased level of aggression, 789 (36.6%) over-crying, 749 (34.7%) sadness, 493 (22.9%) anxiety, 429 (19.9%) anhedonia, 383 (17.8%) confusion, 274 (12.7%) nightmares, 177 (8.2%) avoidance, 174 (8.1%) physical symptoms and 121 (5.6%) bedwetting during the pandemic. General health status was also affected with reported disturbed sleeping pattern (84.6%), altered appetite (50.9%) and weight changes (36.9%), mainly weight gain. Risk factors included being non-national, as well as having lower parental educational level and lower socioeconomic status; while protective factors involved meeting classmates, indoor and outdoor activities, and less screen time.
CONCLUSIONS: COVID19 crisis had drastic impact on children's mental and general health, requiring serious action regarding evaluating this generation and intervening accordingly.
Fulltext New thiosemicarbazides and 1,2,4-triazolethiones derived from 2-(ethylsulfanyl) benzohydrazide as potent antioxidants

Nazarbahjat N, Nordin N, Abdullah Z, Abdulla MA, Yehye WA, Halim SN, et al.

Molecules, 2014;19(8):11520-37.
PMID: 25093989 DOI: 10.3390/molecules190811520

New thiosemicarbazide derivatives 2-6 were synthesised by reacting 2-(ethylsulfanyl)benzohydrazide with various aryl isothiocyanates. The cyclisation of compounds 2-6 under reflux conditions in a basic medium (aqueous NaOH, 4 N) yielded compounds 7-11 that contain a 1,2,4-triazole ring. All of the synthesised compounds were screened for their antioxidant activities. Compounds 2, 3, and 7 showed better radical scavenging in a 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, with IC50 values of 1.08, 0.22, and 0.74 µg/mL, respectively, compared to gallic acid (IC50, 1.2 µg/mL). Compound 3 also showed superior results in a ferric reducing antioxidant power (FRAP) assay (3054 µM/100 g) compared to those of ascorbic acid (1207 µM/100 g).
Fulltext Accelerated nucleophilic substitution reactions of dansyl chloride with aniline under ambient conditions via dual-tip reactive paper spray

Sarih NM, Romero-Perez D, Bastani B, Rauytanapanit M, Boisdon C, Praneenararat T, et al.

Sci Rep, 2020 12 09;10(1):21504.
PMID: 33299034 DOI: 10.1038/s41598-020-78133-4

Paper spray ionization (PSI) mass spectrometry (MS) is an emerging tool for ambient reaction monitoring via microdroplet reaction acceleration. PSI-MS was used to accelerate and monitor the time course of the reaction of dansyl chloride with aniline, in acetonitrile, to produce dansyl aniline. Three distinct PSI arrangements were explored in this study representing alternative approaches for sample loading and interaction; conventional single tip as well as two novel setups, a dual-tip and a co-axial arrangement were designed so as to limit any on-paper interaction between reagents. The effect on product abundance was investigated using these different paper configurations as it relates to the time course and distance of microdroplet travel. It was observed that product yield increases at a given distance and then decreases thereafter for all PSI configurations. The fluorescent property of the product (dansyl aniline) was used to visually inspect the reaction progress on the paper substrate during the spraying process. Amongst the variety of sample loading methods the novel dual-tip arrangement showed an increased product yield and microdroplet density, whilst avoiding any on-paper interaction between the reagents.
Fulltext Effects of home visits on quality of life among older adults: a systematic review protocol

Tay YL, Abu Bakar NS, Tumiran R, Ab Rahman NH, Mohd Ma'amor NAA, Yau WK, et al.

Syst Rev, 2021 Dec 06;10(1):307.
PMID: 34872589 DOI: 10.1186/s13643-021-01862-8

BACKGROUND: Home visiting services for older adults have been offered for decades to maintain and promote health and independent functioning, thus enhancing quality of life. Previous systematic reviews have provided a mixed picture of the benefits of home visiting programmes in older adults, primarily because of heterogeneity in study designs, targeted populations, and intervention strategies. These reviews may also become out of date; thus, an updated synthesis of relevant studies is warranted. Our objective is to perform a systematic review of recently published primary studies on the effectiveness of multi-professional home visits on quality of life among older adults.
METHODS: We will perform a comprehensive search for studies investigating the effect of a multi-professional home visit approach on quality of life among older adults. We will conduct the literature search in selected electronic databases and relevant research websites from January 2010 onwards. We will include randomised controlled trials (RCTs), cluster randomised controlled trials (cluster RCTs), and observational studies that enrolled older adults without dementia over 60 years old, along with studies involving multi-professional preventive-promotive home visit approaches not related to recent hospital discharge. We will report our planned review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will retrieve and record relevant data in a standardised data extraction form and evaluate the quality of the included articles using the Cochrane risk of bias tool and the quality assessment tool for studies with diverse designs (QATSDD). Where appropriate, outcomes will be pooled for meta-analysis using a random-effects model. The main outcomes include quality of life, incidence of falls, depression, dementia, and emergency department admissions.
DISCUSSION: This review may provide evidence for the effectiveness of home visits in improving older adults' quality of life. It will potentially benefit health care professionals, policymakers, and researchers by facilitating the design and delivery of interventions related to older generations and improve service delivery in future.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021234531 .
Role of toll-like receptor 4 antagonist Lipopolysaccharide-Rhodobacter sphaeroides on acute stress-induced voluntary ethanol preference and drinking behaviour: In vivo Swiss Albino mouse model

Chuang HG, Aziz NHA, Wong JH, Mustapha M, Abdullah JM, Idris Z, et al.

Eur Neuropsychopharmacol, 2021 04;45:59-72.
PMID: 32014377 DOI: 10.1016/j.euroneuro.2019.12.121

The present study focused on investigating the effect of toll-like receptor 4 (TLR4) antagonist Lipopolysaccharide-Rhodobacter sphaeroides(LPS-RS) on acute, stress-induced voluntary ethanol preference and drinking behaviour, neuronal components activation, and gene expression associated with stress and addictive behaviour. This study involved the exposure of restraint stress and social isolation using Swiss Albino mice. Two-bottle choice ethanol preference analysis was used in the evaluation of voluntary ethanol seeking and drinking behaviour. Several behavioural assessments were carried out to assess fear and anxiety-like behaviour, neuromuscular ability, motor coordination and locomotion. Morphological and immunoreactivity analysis and gene expression analysis were done after the completion of behavioural assessments. TLR4 antagonist LPS-RS treated stressed-mice showed a significant decrease in ethanol drinking compared with stressed mice. Behavioural results showed that stress exposure induced fear and anxiety-like behaviour; however; no significant deficit was found on motor coordination, neuromuscular ability, locomotion and exploratory behaviour among groups. Morphological analysis showed no significant change in the prefrontal cortex and hippocampus among all groups, while immunoreactivity analysis showed higher expression of c-Fos in prefrontal cortex and hippocampus, higher TLR4 expression in the prefrontal cortex and glial fibrillary acidic protein (GFAP) in hippocampus among stressed-animals. Stressed-mice also showed significant increase in TLR4, Nuclear Factor-Kappa B (NF-kB), inducible nitric oxide synthase (iNOS), dopamine receptor D2 (DRD2), cyclic adenosine monophosphate (cAMP) response element binding protein-1 (CREB-1) and opioid receptor MU-1 (OPRM-1) genes expression compared with control and LPS-RS treated stressed-mice. As a conclusion, the antagonism of TLR4 could provide therapeutic value in the treatment of stress-induced addiction.
Recent advances in halal food authentication: Challenges and strategies

Ng PC, Ahmad Ruslan NAS, Chin LX, Ahmad M, Abu Hanifah S, Abdullah Z, et al.

J Food Sci, 2022 Jan;87(1):8-35.
PMID: 34954819 DOI: 10.1111/1750-3841.15998

Increasing public awareness of food quality and safety has prompted a rapid increase in food authentication of halal food, which covers the production method, technical processing, identification of undeclared components, and species substitution in halal food products. This urges for extensive research into analytical methods to obtain accurate and reliable results for monitoring and controlling the authenticity of halal food. Nonetheless, authentication of halal food is often challenging because of the complex nature of food and the increasing number of food adulterants that cause detection difficulties. This review provides a comprehensive and impartial overview of recent studies on the analytical techniques used in the analysis of halal food authenticity (from 1980 to the present, but there has been no significant trend in the choice of techniques for authentication of halal food during this period). Additionally, this review highlights the classification of different methodologies based on validity measures that provide valuable information for future developments in advanced technology. In addition, methodological developments, and novel emerging techniques as well as their implementations have been explored in the evaluation of halal food authentication. This includes food categories that require halal authentication, illustrating the advantages and disadvantages as well as shortcomings during the use of all approaches in the halal food industry.
Fulltext Audit on cardiovascular disease preventive care in general practice

Chan SC, Lee TW, Teoh LC, Abdullah ZC, Xavier G, Sim CK, et al.

Singapore Med J, 2008 Apr;49(4):311-5.
PMID: 18418523

INTRODUCTION: Cardiovascular disease is a major cause of morbidity and mortality. Primary care doctors as general practitioners (GPs) play a central role in prevention, as they are in contact with a large number of patients in the community through provision of first contact, comprehensive and continuing care. This study aims to assess the adequacy of cardiovascular disease preventive care in general practice through a medical audit.
METHODS: Nine GPs in Malaysia did a retrospective audit on the records of patients, aged 45 years and above, who attended the clinics in June 2005. The adequacy of cardiovascular disease preventive care was assessed using agreed criteria and standards.
RESULTS: Standards achieved included blood pressure recording (92.4 percent), blood sugar screening (72.7 percent) and attaining the latest blood pressure of equal or less than 140/90 mmHg in hypertensive patients (71.3 percent). Achieved standards ranged from 11.1 percent to 66.7 percent in the maintenance of hypertension and diabetic registries, recording of smoking status, height and weight, screening of lipid profile and attaining target blood sugar levels in diabetics.
CONCLUSIONS: In the nine general practice clinics audited, targets were achieved in three out of ten indicators of cardiovascular preventive care. There were vast differences among individual clinics.
Development of chemometric-assisted supercritical fluid extraction of effective and natural tyrosinase inhibitor from Syzygium aqueum leaves

Zarudin NH, Normaya E, Shamsuri SS, Iqbal A, Mat Piah MB, Abdullah Z, et al.

Int J Biol Macromol, 2024 Feb;258(Pt 2):129168.
PMID: 38171432 DOI: 10.1016/j.ijbiomac.2023.129168

Tyrosinase is a key enzyme in enzymatic browning, causing quality losses in food through the oxidation process. Thus, the discovery of an effective and natural tyrosinase inhibitor via green technology is of great interest to the global food market due to food security and climate change issues. In this study, Syzygium aqueum (S. aqueum) leaves, which are known to be rich in phenolic compounds (PC), were chosen as a natural source of tyrosinase inhibitor, and the effect of the sustainable, supercritical fluid extraction (SFE) process was evaluated. Response surface methodology-assisted supercritical fluid extraction (RSM-assisted SFE) was utilized to optimize the PCs extracted from S. aqueum. The highest amount of PC was obtained at the optimum conditions (55 °C, 3350 psi, and 70 min). The IC50 (661.815 μg/mL) of the optimized extract was evaluated, and its antioxidant activity (96.8 %) was determined. Gas chromatography-mass spectrometry (GC-MS) results reveal that 2',6'-dihydroxy-4'-methoxychalcone (2,6-D4MC) (82.65 %) was the major PC in S. aqueum. Chemometric analysis indicated that 2,6-D4MC has similar chemical properties to the tyrosinase inhibitor control (kaempferol). The toxicity and physiochemical properties of the novel 2,6-D4MC from S. aqueum revealed that the 2,6-D4MC is safer than kaempferol as predicted via absorption, distribution, metabolism, and excretion (ADME) evaluation. Enzyme kinetic analysis shows that the type of inhibition of the optimized extract is non-competitive inhibition with Km = 1.55 mM and Vmax = 0.017 μM/s. High-performance liquid chromatography (HPLC) analysis shows the effectiveness of S. aqueum as a tyrosinase inhibitor. The mechanistic insight of the tyrosinase inhibition using 2,6-D4MC was successfully calculated using density functional theory (DFT) and molecular docking approaches. The findings could have a significant impact on food security development by devising a sustainable and effective tyrosinase inhibitor from waste by-products that is aligned with the United Nation's SDG 2, zero hunger.
Fulltext The political economy of health financing reform in Malaysia

Croke K, Mohd Yusoff MB, Abdullah Z, Mohd Hanafiah AN, Mokhtaruddin K, Ramli ES, et al.

Health Policy Plan, 2019 Dec 01;34(10):732-739.
PMID: 31563946 DOI: 10.1093/heapol/czz089

There is growing evidence that political economy factors are central to whether or not proposed health financing reforms are adopted, but there is little consensus about which political and institutional factors determine the fate of reform proposals. One set of scholars see the relative strength of interest groups in favour of and opposed to reform as the determining factor. An alternative literature identifies aspects of a country's political institutions-specifically the number and strength of formal 'veto gates' in the political decision-making process-as a key predictor of reform's prospects. A third group of scholars highlight path dependence and 'policy feedback' effects, stressing that the sequence in which health policies are implemented determines the set of feasible reform paths, since successive policy regimes bring into existence patterns of public opinion and interest group mobilization which can lock in the status quo. We examine these theories in the context of Malaysia, a successful health system which has experienced several instances of proposed, but ultimately blocked, health financing reforms. We argue that policy feedback effects on public opinion were the most important factor inhibiting changes to Malaysia's health financing system. Interest group opposition was a closely related factor; this opposition was particularly powerful because political leaders perceived that it had strong public support. Institutional veto gates, by contrast, played a minimal role in preventing health financing reform in Malaysia. Malaysia's dramatic early success at achieving near-universal access to public sector healthcare at low cost created public opinion resistant to any change which could threaten the status quo. We conclude by analysing the implications of these dynamics for future attempts at health financing reform in Malaysia.
Hybrid Organizations in Health Systems: The Corporatization of Malaysia's National Heart Institute

Virk A, Croke K, Mohd Yusoff M, Mokhtaruddin K, Abdullah Z, Nadziha Mohd Hanafiah A, et al.

Health Syst Reform, 2020 12 01;6(1):e1833639.
PMID: 33314988 DOI: 10.1080/23288604.2020.1833639

Health system reforms across high- and middle-income countries often involve changes to public hospital governance. Corporatization is one such reform, in which public sector hospitals are granted greater functional independence while remaining publicly owned. In theory, this can improve public hospital efficiency, while retaining a public service ethos. However, the extent to which efficiency gains are realized and public purpose is maintained depends on policy choices about governance and payment systems. We present a case study of Malaysia's National Heart Institute (IJN), which was created in 1992 by corporatization of one department in a large public hospital. The aim of the paper is to examine whether IJN has achieved the goals for which it was created, and if so, whether it provides a potential model for further reforms in Malaysia and other similar health systems. Using a combination of document analysis and key informant interviews, we examine key governance, health financing and payment, and equity issues. For governance, we highlight the choice to have IJN owned by and answerable to a Ministry of Finance (MOF) holding company and MOF-appointed board, rather than the Ministry of Health (MOH). On financing and payment, we analyze the implications of IJN's combined role as fee-for-service provider to MOH as well as provider of care to private patients. For equity, we analyze the targeting of IJN care across publicly-referred and private patients. These issues demonstrate unresolved tensions between IJN's objectives and public service goals. As an institutional innovation that has endured for 28 years and grown dramatically in size and revenue, IJN's trajectory offers critical insights on the relevance of the hybrid public-private models for hospitals in Malaysia as well as in other middle-income countries. While IJN appears to have achieved its goal of establishing itself as a commercially viable, publicly owned center of clinical excellence in Malaysia, the value for money and equity of the services it provides to the Ministry of Health remain unclear. IJN is accountable to a small Ministry of Finance holding company, which means that detailed information required to evaluate these critical questions is not published. The case of IJN highlights that corporatization cannot achieve its stated goals of efficiency, innovation, and equity in isolation; rather it must be supported by broader reforms, including of health financing, payment, governance, and transparency, in order to ensure that autonomous hospitals improve quality and provide efficient care in an equitable way.

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