Displaying publications 81 - 100 of 134 in total

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  1. Mahmud KA, Zakaria R, Azman M, Mat Baki M
    ORL J Otorhinolaryngol Relat Spec, 2021 05 05;83(4):295-298.
    PMID: 33951656 DOI: 10.1159/000515424
    Adult laryngeal haemangioma is normally seen in the supraglottic or glottic region. Transglottic haemangioma is unusual, and treatment with primary endolaryngeal surgical excision may lead to undesirable bleeding and poor voice outcomes. A 25-year-old female presented with hoarseness and progressive upper airway obstruction symptoms. Videoendoscopy showed haemangioma involving all unilateral subunits of the larynx obstructing half of the subglottis. The transglottic haemangioma was treated with endolaryngeal ethanol injection with prior tracheostomy under local anaesthesia. Endolaryngeal laser surgery was performed later on to remove small residual haemangioma and granuloma. The haemangioma resolved; however, the ethanol injection to the paraglottic space results in vocal fold immobility but with favourable position and good muscle tone and bulk. The patient was successfully decannulated. Post-intervention subjective and objective voice assessments showed normal parameters except slight impairment of voice handicap index-10 with a total score of 12. Adult transglottic haemangioma can cause upper airway obstruction and requires intervention. Excision of the lesion endoscopically without sacrificing voice is achievable.
  2. Juperi S, Zakaria R, Mansor A
    Trop Life Sci Res, 2012 May;23(1):35-44.
    PMID: 24575224 MyJurnal
    To investigate the distribution of Anacardiaceae in Teluk Bahang Permanent Forest Reserve (TBPFR) in Pulau Pinang, all trees with a diameter at breast high (DBH) ≥ 5 cm were enumerated in a study site constituting 0.4 ha of the reserve. Seventy five individuals of Anacardiaceae (14% of all trees) are recorded. These individuals represent 4 genera and 5 species, namely, Mangifera pentandra, Mangifera macrocarpa, Gluta elegans, Campnosperma auriculatum and Swintonia floribunda. The mean density of Anacardiaceae within the study plots is 7.50±8.14 (mean±S.D.) per ha whereas the basal area (BA) calculated is 0.97 m(2)/0.40 ha. The importance value (IVi) for Anacardiaceae is 81%. The estimated total aboveground biomass (TAGB) for Anacardiaceae is 24.24 ton/0.40 ha. A total of 333 Anacardiaceae saplings with a DBH < 5 cm are recorded. These saplings have been identified as juveniles of the genera Gluta (9.99%), Swintonia (84.90%) and Mangifera (5.11%).
  3. Abdo Qaid EY, Abdullah Z, Zakaria R, Long I
    Int J Mol Sci, 2022 Nov 03;23(21).
    PMID: 36362262 DOI: 10.3390/ijms232113474
    Neuroinflammation following lipopolysaccharide (LPS) administration induces locomotor deficits and anxiety-like behaviour. In this study, minocycline was compared to memantine, an NMDA receptor antagonist, for its effects on LPS-induced locomotor deficits and anxiety-like behaviour in rats. Adult male Sprague Dawley rats were administered either two different doses of minocycline (25 or 50 mg/kg/day, i.p.) or 10 mg/kg/day of memantine (i.p.) for 14 days four days prior to an LPS (5 mg/kg, i.p.) injection. Locomotor activity and anxiety-like behaviour were assessed using the open-field test (OFT). The phosphorylated tau protein level was measured using ELISA, while the expression and density of brain-derived neurotrophic factor (BDNF) and cAMP response element-binding (CREB) protein in the medial prefrontal cortex (mPFC) were measured using immunohistochemistry and Western blot, respectively. Minocycline treatment reduced locomotor deficits and anxiety-like behaviour associated with reduced phosphorylated tau protein levels, but it upregulated BDNF/CREB protein expressions in the mPFC in a comparable manner to memantine, with a higher dose of minocycline having better benefits. Minocycline treatment attenuated LPS-induced locomotor deficits and anxiety-like behaviour in rats and decreased phosphorylated tau protein levels, but it increased the expressions of the BDNF/CREB proteins in the mPFC.
  4. Qaid EYA, Abdullah Z, Zakaria R, Long I
    Neurochem Res, 2023 May;48(5):1480-1490.
    PMID: 36509985 DOI: 10.1007/s11064-022-03842-3
    The oxidative stress-induced dysregulation of the cyclic AMP response element-binding protein- brain-derived neurotrophic factor (CREB-BDNF) cascade has been linked to cognitive impairment in several studies. This study aimed to investigate the effect of minocycline on the levels of oxidative stress markers, CREB, and BDNF in lipopolysaccharide (LPS)-induced cognitive impairment. Fifty adult male Sprague Dawley rats were divided randomly into five groups. Group 1 was an untreated control group. Groups 2, 3, 4 and 5 were treated concurrently with LPS (5 mg/kg, i.p) once on day 5 and normal saline (0.7 ml/rat, i.p) or minocycline (25 and 50 mg/kg, i.p) or memantine (10 mg/kg, i.p) once daily from day 1 until day 14, respectively. From day 15 to day 22 of the experiment, Morris Water Maze (MWM) was used to evaluate learning and reference memory in rats. The levels of protein carbonyl (PCO), malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD) were determined by enzyme-linked immunosorbent assay (ELISA). CREB and BDNF expression and density were measured by immunohistochemistry and western blot analysis, respectively. LPS administration significantly increased escape latency to the hidden platform with decreased travelled distance, swimming speed, target crossings and time spent in the target quadrant. Besides, the hippocampal tissue of LPS rats showed increased levels of PCO and MDA, decreased levels of CAT and SOD, and reduced expression and density of BDNF and CREB. Treatment with minocycline reversed these effects in a dose-dependent manner, comparable to the effects of memantine. Both doses of minocycline treatment protect against LPS-induced cognitive impairment by reducing oxidative stress and upregulating the CREB-BDNF signalling pathway in the rat hippocampus.
  5. Abdo Qaid EY, Abdullah Z, Zakaria R, Long I
    Neurol Res, 2024 Mar;46(3):261-271.
    PMID: 38122814 DOI: 10.1080/01616412.2023.2296754
    INTRODUCTION: The neuroinflammatory response was seen to impact the formation of phosphorylated tau protein in Alzheimer's disease (AD). This study aims to investigate the molecular mechanism of minocycline in reducing phosphorylated tau protein formation in the hippocampus of lipopolysaccharide (LPS)-induced rats.

    METHODS: Fifty adult male Sprague Dawley (SD) rats were randomly allocated to 1 of 5 groups: control, LPS (5 mg/kg), LPS + minocycline (25 mg/kg), LPS + minocycline (50 mg/kg) and LPS + memantine (10 mg/kg). Minocycline and memantine were administered intraperitoneally (i.p) for two weeks, and LPS was injected i.p. once on day 5. ELISA was used to determine the level of phosphorylated tau protein in SD rats' hippocampal tissue. The density and expression of Toll-like receptor-4 (TLR-4), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-кβ), tumour necrosis factor-alpha (TNF-α), and cyclooxygenase (COX)-2 were determined using Western blot and immunohistochemistry.

    RESULTS: Minocycline, like memantine, prevented LPS-induced increasein phosphorylated tau protein level suggested via reduced density and expression of TLR-4, NF-кβ, TNF-αand COX-2 proteins in rat hippocampal tissue. Interestingly, higher doses were shown to be more neuroprotective than lower doses.

    CONCLUSION: This study suggests that minocycline suppresses the neuroinflammation signalling pathway and decreased phosphorylated tau protein formation induced by LPS in a dose-dependent manner. Minocycline can be used as a preventative and therapeutic drug for neuroinflammatory diseases such as AD.

  6. Abdo Qaid EY, Abdullah Z, Zakaria R, Long I
    Int J Neurosci, 2024 Jun;134(1):56-65.
    PMID: 35638219 DOI: 10.1080/00207454.2022.2084092
    PURPOSE/AIM: Neuroinflammation and oxidative stress have been encountered in neurodegenerative diseases such as Alzheimer's disease (AD). However, the neuroprotective effects of minocycline against lipopolysaccharide (LPS)-induced glial cells activation and oxidative stress damage in the medial prefrontal cortex (mPFC) of rats are still elusive. The purpose of this study is to investigate the effects of minocycline and memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist, on the microglia and astrocytes expression, as well as oxidative stress levels in the mPFC of LPS injected rats.

    MATERIALS AND METHODS: Fifty adult Male Sprague Dawley rats were divided into five groups: control, LPS (5 mg/kg), LPS treated with minocycline (25 mg/kg), LPS treated with minocycline (50 mg/kg) and LPS treated with memantine (10 mg/kg). The immunohistochemistry and western blotting were used to analyse the expressions and densities of microglia marker (Iba-1) and astrocyte marker, (GFAP) while enzyme-linked immunosorbent assay (ELISA) was used to measure the protein carbonyl (PCO), malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD) levels.

    RESULTS: In comparison to the control group, the expression and density of Iba-1 and GFAP were significantly enhanced in the LPS group (p 

  7. Che Ya SN, Muhamad R, Mohd Zain N, Zakaria R, Ishak A, Hassan II, et al.
    Sex Med, 2021 Jun;9(3):100336.
    PMID: 33794448 DOI: 10.1016/j.esxm.2021.100336
    INTRODUCTION: Women' sexuality becomes complex after breast cancer diagnosis and sexual health is highly neglected in the management of the illness.

    AIMS: To explore the coping and strategies to overcome sexuality problems and sexual dysfunction among women with breast cancer.

    MATERIAL AND METHODS: Using the in-depth and photo-elicitation interview methods, this qualitative study following phenomenological analysis was conducted on fourteen married female respondents with breast cancer and had the positive result for female sexual dysfunction (FSD) screened by Female Sexual Function Index (FSFI-6 items) from Kelantan, Malaysia. The interviews data were audio-recorded, transcribed verbatim and managed in analytic computer software NVivo11 Pro. The transcriptions were analyzed using thematic analysis by referring to the meaning-making theory.

    MAIN OUTCOME MEASURES: We identified overlapping themes of coping and strategies among women with breast cancer to overcome sexual problems and sexual dysfunction which correspond with meaning-making theory.

    RESULTS: Three themes have emerged. Women with breast cancer that developed sexuality problem and sexual dysfunction strived to accept the illness using religious belief and conform by altering sexual practices. These individuals positively look for a solution by seeking formal healthcare advice, modify their physical appearance, active discussion with the husband and support from other survivors. A few of them passively struggle with the subject by averting the intimacy and receptive toward polygamy.

    CONCLUSION: This study highlighted the various mechanisms that emphasized the pivotal role of religious belief and relationship context as key factors in the coping strategies among women with breast cancer in Malaysia. The finding may not be generalized to other countries. Che Ya SN, Muhamad R, Zain NM, et al. Coping Strategies for Sexual Problems and Sexual Dysfunction Amongst Malay Women With Breast Cancer. A Qualitative Study. Sex Med 2021;9:100336.

  8. Che Ya SN, Muhamad R, Zakaria R, Mohd Zain N, Ishak A, Hassan II, et al.
    Arch Sex Behav, 2021 Nov 08.
    PMID: 34750771 DOI: 10.1007/s10508-021-02051-3
    Sexuality is currently neglected in the medical care of cancer patients although female sexual dysfunction (FSD) and sexual problems are highly prevalent among breast cancer patients in Malaysia. This paper explores the consequences of breast cancer and its treatment on the sexuality and sexual health of women with breast cancer using a qualitative design and a phenomenological methodology. Fourteen married women with breast cancer who fulfill the criteria for FSD from Kelantan, Malaysia participated in two interviews: in-depth interview and followed by photo-elicitation interview after two weeks duration. The interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. We identified overlapping themes that can be explained by sexual script theory. Breast cancer treatments disturb the sex response cycle, leading to changes in sexuality, from intimacy in marriage to women preferring physical affection to intercourse. The women struggled with a perceived imperfection about symbol of femininity after noticing changes in their husbands' sexual performance and after experiencing their own sentiments of inadequacy as a wife. Fear and guilt surfaced as part of the journey, accompanied by frustration on the part of the spouse, or him becoming more attentive. This study highlights the problem of breast cancer and its treatment as regards the sexual well-being of patients and their spouses. Hence, recognizing and addressing sexual health will improve the overall experience for survivors.
  9. Lee YJ, Zakaria R, Manaf ZA, Mohamed Z, Lee YY
    Chin Med J (Engl), 2013;126(11):2049-53.
    PMID: 23769556
    There is increasing evidence that CT pulmonary arteriography and venography allow a better diagnostic yield for deep vein thrombosis (DVT) in suspected acute pulmonary embolism (PE). The aim was to investigate the value for using such an approach in a multiracial Asian population.
  10. Liu K, Fadzly N, Mansor A, Zakaria R, Ruppert N, Lee CY
    Plant Signal Behav, 2017 Oct 03;12(10):e1371890.
    PMID: 28841358 DOI: 10.1080/15592324.2017.1371890
    Amorphophallus bufo is a rarely studied plant in Malaysian tropical rainforests. We measured the spectral reflectance of different developmental stages of A. bufo (seedlings, juveniles and adults), background soil/ debris and leaves from other neighboring plant species. Results show that the leaves of A. bufo seedling have a similar reflectance curve as the background soil and debris. Adults and juveniles of A. bufo are similar to other neighboring plants' leaf colors. We hypothesize that the cryptic coloration of A. bufo seedlings plays an important role in camouflage and that the numerous black spots on the surface of the petioles and rachises, may serve as a defensive mimicry against herbivores.
  11. Mohd Basri MS, Liew Min Ren B, A Talib R, Zakaria R, Kamarudin SH
    Polymers (Basel), 2021 May 14;13(10).
    PMID: 34069259 DOI: 10.3390/polym13101581
    Dry mangosteen leaves are one of the raw materials used to produce marker ink. However, research using this free and abundant resource is rather limited. The less efficient one-factor-at-a-time (OFAT) approach was mostly used in past studies on plant-based marker ink. The use of statistical analysis and the regression coefficient model (mathematical model) was considered essential in predicting the best combination of factors in formulating mangosteen leaf-based marker ink. Ideally, ink should have maximum color lightness, minimum viscosity, and fast-drying speed. The objective of this study to study the effect of glycerol and carboxymethyl cellulose (CMC) on the color lightness and viscosity of mangosteen-leaves-based marker ink. The viscosity, color lightness, and drying properties of the ink were tested, the significant effect of glycerol and CMC (responses) on ink properties was identified and the prediction model on the optimum value of the responses was developed by using response surface methodology (RSM). The microstructure of mangosteen leaves was analyzed to study the surface morphology and cell structure during dye extraction. A low amount of glycerol used was found to increase the value of color lightness. A decrease in CMC amounts resulted in low viscosity of marker ink. The optimum formulation for the ink can be achieved when the weight percents of glycerol, benzalkonium chloride, ferrous sulphate, and CMC are set at 5, 5, 1, and 3, respectively. SEM micrographs showed the greatest amount of cell wall structure collapse on samples boiled with the lowest amount of glycerol.
  12. Teridi MA, Sookhakian M, Basirun WJ, Zakaria R, Schneider FK, da Silva WJ, et al.
    Nanoscale, 2015 Apr 28;7(16):7091-100.
    PMID: 25640454 DOI: 10.1039/c4nr05874g
    High performance organic devices including polymer solar cells (PSCs) and light emitting diodes (PLEDs) were successfully demonstrated with the presence of highly ordered nanoimprinted Au nanodisks (Au NDs) in their solution-processed active/emissive layers, respectively. PSCs and PLEDs were fabricated using a low bandgap polymer and acceptor, nitrogen doped multiwalled carbon nanotubes poly[4,8-bis[(2-ethylhexyl)oxy]benzo[1,2-b:4,5-b']dithiophene-2,6-diyl][3-fluoro-2-[(2-ethylhexyl)carbonyl] thieno[3,4-b]-thiophenediyl] (n-MWCNTs:PTB7), and [6,6]-phenyl C71 butyric acid methyl ester (PC71BM) and (4,4-N,N-dicarbazole) biphenyl (CBP) doped with tris(2-phenylpyridine) iridium(iii) (Ir(ppy)3) as active/emissive layers, respectively. We synthesized nitrogen doped graphene and used it as anodic buffer layer in both devices. The localized surface plasmon resonance (LSPR) effect from Au NDs clearly contributed to the increase in light absorption/emission in the active layers from electromagnetic field enhancement, which originated from the excited LSPR in PSCs and PLEDs. In addition to the high density of LSPR and strong exciton-SP coupling, the electroluminescent (EL) enhancement is ascribed to enhanced spontaneous emission rates. This is due to the plasmonic near-field effect induced by Au NDs. The PSCs and PLEDs exhibited 14.98% (8.08% to 9.29%) under one sun of simulated air mass 1.5 global (AM1.5G) illumination (100 mW cm(-2)) and 19.18% (8.24 to 9.82 lm W(-1)) enhancement in the power conversion efficiencies (PCEs) compared to the control devices without Au NDs.
  13. Zakaria R, Sutan R, Jaafar R
    PMID: 32642469 DOI: 10.4103/jehp.jehp_497_19
    INTRODUCTION: Educating a mother of a premature baby and providing a structured written educational information can enhance better understanding and practice. This article describes the development and implementation of a health educational package for preemie moms in the care of their premature baby after neonatal intensive care unit discharge.

    SUBJECTS AND METHODS: The package known as "Preemie Mom: A Guide for You" was designed based on Stufflebeam's model and has four phases: (1) content evaluation from available sources of information, (2) input evaluation based on mothers' need related to premature baby care, (3) process evaluation for package designing and content drafting, and (4) product evaluation to determine its feasibility. The contents were extracted and collated for validation by consulting various specialists in related fields. A final draft was drawn based on comments given by experts. Comments from the mothers were taken for formatting, visual appearance, and content flow for easy understanding and usage.

    RESULTS: All ten existing articles and eight relevant documents were gathered and critically appraised. The package was designed based on 11 main components related to the care of premature baby after discharge. The content validation was accepted at a minimum score of 0.85 for the item-level content validity index analysis. Both experts and mothers were agreed that the package is easy to use and well accepted as a guide after discharge. The agreement rate by the mothers was at 93.33% and greater for the front page, writing style, structure, presentation, and motives of the package.

    CONCLUSIONS: "Preemie Mom: A Guide for You" is a validated health educational package and ready to be used to meet the needs of the mother for premature baby care at home.

  14. Azman KF, Aziz CBA, Zakaria R, Ahmad AH, Shafin N, Ismail CAN
    Molecules, 2021 Sep 06;26(17).
    PMID: 34500857 DOI: 10.3390/molecules26175424
    Tualang honey has been shown to protect against neurodegeneration, leading to improved memory/learning as well as mood. In addition, studies have also demonstrated its anti-inflammatory and antioxidant properties. However, a substantial part of this research lacks systematization, and there seems to be a tendency to start anew with every study. This review presents a decade of research on Tualang honey with a particular interest in the underlying mechanisms related to its effects on the central nervous system. A total of 28 original articles published between 2011 and 2020 addressing the central nervous system (CNS) effects of Tualang honey were analysed. We identified five main categories, namely nootropic, antinociceptive, stress-relieving, antidepressant, and anxiolytic effects of Tualang honey, and proposed the underlying mechanisms. The findings from this review may potentially be beneficial towards developing new therapeutic roles for Tualang honey and help in determining how best to benefit from this brain supplement.
  15. Khir NAM, Noh ASM, Long I, Zakaria R, Ismail CAN
    Mol Cell Biochem, 2024 Mar;479(3):539-552.
    PMID: 37106243 DOI: 10.1007/s11010-023-04749-5
    The role of carbon monoxide (CO) has evolved albeit controversial disputes on its toxicity. This biological gasotransmitter participates in the endogenous regulation of neurotransmitters and neuropeptides released in the nervous system. Exogenous CO gas inhalation at a lower concentration has been the subject of investigations, which have revealed its biological homeostatic mechanisms and protective effects against many pathological conditions. This therapeutic procedure of CO is, however, limited due to its immediate release, which favours haemoglobin at a high affinity with the subsequent generation of toxic carboxyhaemoglobin in tissues. In order to address this problem, carbon monoxide releasing molecule-2 (CORM-2) or also known as tricarbonyldichlororuthenium II dimer is developed to liberate a controlled amount of CO in the biological systems. In this review, we examine several potential mechanisms exerted by this therapeutic compound to produce the anti-nociceptive effect that has been demonstrated in previous studies. This review could shed light on the role of CORM-2 to reduce pain, especially in cases of chronic and neuropathic pain.
  16. Yeoh SL, Choong PS, Zakaria R, Kamaruzaman NA, Md Rashid S, Razali MF, et al.
    Toxicon, 2024 Jan;237:107557.
    PMID: 38072318 DOI: 10.1016/j.toxicon.2023.107557
    Derris trifoliata is mainly found in mangrove area in tropical regions and the plant extract is traditionally used for fishing by poisoning. This is the first case report of rotenone poisoning in a child from ingesting Derris trifoliata seed. The child developed altered consciousness, vomiting, hypotension, metabolic acidosis, and acute kidney injury. Species identification of this case requires the collaborative efforts of various agencies. She survived from the poisoning with no neurological sequelae.
  17. Zakaria R, Bawon P, Lee SH, Salim S, Lum WC, Al-Edrus SSO, et al.
    Polymers (Basel), 2021 Oct 12;13(20).
    PMID: 34685253 DOI: 10.3390/polym13203494
    The study investigated the effects of the addition of starch on the properties of oil palm biomass particleboard bonded with citric acid. Three kinds of oil palm biomasses were used in this study for the fabrication of particleboard, namely, oil palm frond (OPF), oil palm trunk (OPT), and empty fruit bunch (EFB) particles. Citric acid and tapioca starch at the mixing ratios of 100:0, 87.5:12.5, and 75:25 were prepared at a 60% solid content. A 30% resin content based on the oven-dried weight of the oil palm biomass particles was used. The sprayed particles were pre-dried at 80 °C for 12 h before being hot-pressed at 180 °C and 4 MPa pressure for 10 min. The physical and mechanical properties of the particleboard were evaluated. The mixtures of citric acid and tapioca starch were characterized by thermogravimetric analysis (TGA). Thermal stability of citric acid was reduced after the addition of tapioca starch. The addition of 12.5% tapioca starch improved the bending strength of the particleboard but increased the thickness swelling slightly. All UF-bonded particleboard exhibited significantly inferior performance than that of citric-acid-bonded particleboard. Citric-acid-bonded particleboard maintained its original shape after being subjected to a cyclic-aging treatment, while the UF-bonded particleboard disintegrated half way through the treatment. The performance of EFB particleboard was significantly inferior to its OPT and OPF counterparts.
  18. Selamat R, Zain F, Raib J, Zakaria R, Marzuki MS, Ibrahim TF
    J Am Coll Nutr, 2011 Dec;30(6):522-8.
    PMID: 22331687
    OBJECTIVE: To study the validity of the visual clinical assessment of weight relative to length and length relative to age as compared to the World Health Organization (WHO) 2006 standard and National Center for Health Statistics (NCHS) 1977 reference in asssessing the physical growth of children younger than 1 year.

    MATERIALS AND METHODS: A prospective cohort study was carried out among 684 infants attending goverment health clinics in 2 states in Malaysia. Body weight, length, and clinical assessment were measured on the same day for 9 visits, scheduled every month until 6 months of age and every 2 months until 12 months of age. All of the 3 z-scores for weight for age (WAZ), length for age (HAZ), and weight for length (WHZ) were calculated using WHO Anthro for Personal Computers software.

    RESULTS: The average sensitivity and specificity for the visual clinical assessment for the detection of thinness were higher using the WHO 2006 standard as compared with using NCHS 1977. However, the overall sensitivity of the visual clinical assessment for the detection of thin and lean children was lower from 1 month of age until a year as compared with the WHO 2006 standard and NCHS 1977 reference. The positive predictive value (PPV) for the visual clinical assessment versus the WHO 2006 standard was almost doubled as compared with the PPV of visual clinical assessment versus the NCHS 1977 reference. The overall average sensitivity, specificity, PPV, and negative predictive value for the detection of stunting was higher for visual clinical assessment versus the WHO 2006 standard as compared with visual clinical assessment versus the NCHS 1977 reference.

    CONCLUSION: The sensitivity and specificity of visual clinical assessment for the detection of wasting and stunting among infants are better for the WHO 2006 standard than the NCHS 1977 reference.

  19. Md Said R, Mohd Zain R, Chan HK, Soelar SA, Rusli N, Nasir NH, et al.
    J Viral Hepat, 2020 06;27(6):638-643.
    PMID: 31997563 DOI: 10.1111/jvh.13267
    Approximately 2.5% of the Malaysian population is currently living with hepatitis C virus (HCV) infection. Yet, the public awareness of the disease is limited and under-screening remains a major challenge. With the support of international non-for-profit organizations, the Ministry of Health in Malaysia recently launched a one-week nationwide hepatitis C screening campaign in conjunction with the World Hepatitis Day. For the first time, the rapid diagnostic test (RDT) for HCV screening was introduced in public health institutions. This campaign involved 49 hospitals and 38 health clinics across the country, targeting the adult general population with unknown HCV infection status. Of the 11 382 participants undergoing the RDT, 1.9% were found to be positive for hepatitis C antibody (anti-HCV) and were referred to on-site medical departments or nearby hospitals for confirmatory testing and treatment. Men, the Malay ethnic group, intranasal and injection drug users and ex-prisoners were shown to have higher odds of being positive for anti-HCV. In addition to serving as a model to educate the general population about the disease, this campaign demonstrates the feasibility of decentralizing HCV screening, particularly by promoting the use of RDT, and linking the HCV-infected patients to care in Malaysia.
  20. Markby J, Shilton S, Sem X, Chan HK, Md Said R, Siva S, et al.
    BMJ Open, 2021 Dec 24;11(12):e055142.
    PMID: 34952885 DOI: 10.1136/bmjopen-2021-055142
    INTRODUCTION: To achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.

    METHODS: This observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.

    RESULTS: During the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).

    CONCLUSIONS: This study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.

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